DEFINITION

Use of sinusoidal, low frequency (30 - 120 Hz), sound pressure waves, blended with music, for therapeutic use.

The principle and method were publicly described for the first time by Olav Skille at the first ISFMIM symposium in 1982. The members of ISVA have, by 1991, collected experiences from more than 30.000 hours of practical use of VibroAcoustic therapy. Most descriptions are of anecdotal nature, and have mainly been centred around testing out the validity of Skille's descriptions and findings. The effect of the therapy can be divided in three main areas:

1. Spasmolytic and muscle relaxing effect.

2. Increase of blood circulation in the body.

3. Marked, but varying effect on the vegetative system.

VA-therapy has a physical direction which is more profound than most other therapies which use music and sounds as the therapeutic medium. Music and the massaging frequencies are transferred directly to the body of the client, who is sitting in a chair or lying on a bed which are equipped with loudspeakers.

HISTORY

VibroAcoustic therapy has been known and used since 1980. The equipment in use has been subject to great improvements during the years which have passed since then.

The equipment was first used as an aid for physical stimulation of children with multiple physical and mental handicaps. It was impossible to provide statistically significant data on the results of this therapy using a small day-care centre as the basis of study. Olav Skille therefore wrote several articles in Norwegian and Nordic journals. This resulted in several cooperation projects in Norway, Finland (Petri Lehikoinen) and England (A.L. Wigram and L. Weekes).

Ethical reasons made it necessary that the therapists and the staff tried the equipment and its effects on themselves before it was tried on the patients. The reports which were submitted showed us that the treatment has effects on several conditions which often were found in the staff. The evolution of the method continued until we in 1987 could offer treatment in TRILAX Centres in Norway. The experiences from these centres showed us that the equipment should be used only by therapists having a professional background in medicine or paramedicine/therapy. The equipment also proved to be suitable for private use for patients who prefer being treated at home.

The reports proved that VA-equipment could have positive effects on conditions which can be described in medical terms, and we soon understood that the equipment also might produce negative effects when it was used by unskilled persons.

Empirical data gave us knowledge on the effects of the different Hz values, and we started to receive reports on the effects of the combination of music and low frequency therapy frequencies.

There are now about 500 units in operation around the world, most of them in Europe.

As the staff was able to report positive effects of the use of VibroAcoustic equipment on conditions which could be described in medical terms, the demands for precise medical reports of findings emerged. The staff gained knowledge about the special effects which could be observed at certain Hz levels. This indicated that we were working with equipment which could be used - and abused.

Highly qualified experts on university level ,- professors in humanistic, medical and technical disciplines were involved in a research group, which was supposed to co-ordinate goal-oriented research activities. It soon appeared that money was used for developing the equipment, and that means for scientific studies not could be provided. Olav Skille therefore had to try to find researchers who were able to fit VibroAcoustic research into their own research activities - without asking for economical compensation for their work. These researchers were included as members of the International Society for VibroAcoustics (ISVA). The necessary equipment was provided by Olav Skille, or by finding local means of economical funding.

The medical science has been very positive to this new therapeutic method, but has been asking for written material before full-scale research projects could be established. When the most immediate scientific need the first years was to provide such written material, it is evident that the collection of data which could satisfy statistical criteria was difficult. If one could not collect precise, statistical data, it was important to get as much data from daily use as possible, so the sheer bulk of empirical data could be convincing.

Luckily, enthusiastic staff members and therapists understood this method of "internal massage" by means of low frequency, pulsating sound pressure waves in combination with music. Their experiences are included in the reports which constitute the basic material of this manual. It is their every-day work with patients and clients which has made it possible to publish this users' manual.

BASIC THEORY

Man has used music in functional contexts as long as man's memory goes backward in history.

We know that the technical equipment of to-day is helping us to use music for relaxation, for receiving energy, to create moods and to serve as auditive background for film and video. We know how music of different kinds fill us with emotions of joy and sorrow. Music and suggestions are joined to create programs which makes it possible for the busy man of to-day to fight stress. It is also used for getting athletes to "explode" just right and in the just right moment.

All this, however is aimed at the ear's reception of sound.

Sound is mechanical vibrations in solid matter, liquids or gases. Sound can be transformed to electromagnetic energy and thus be sent over vast distances (telephone, radio etc.), but has to be transformed back to mechanical vibrations again if we are to perceive the sound. The human ear can perceive sounds between 16 Hz (cycles per second) and ca. 24 000 Hz. This corresponds to 10 octaves in the musical language. (A piano has got a span of a little more than 7 octaves).

If we touch the membrane of a loudspeaker, or are placed close to the loudspeakers in a discotheque, we can feel the pressure of the sound as vibrations, or as direct "hits" transferred by the air. Thus we find that it is not only the ear which can receive sound waves. There is a possibility that sound can be perceived directly by the body, by the registration and perception organs we can find there.

Acoustically speaking - the body is nothing but a skin sack filled with water. If we imagine such a sack being placed upon a series of loudspeakers and send bass sound through these, we have no difficulty in understanding that the sound vibrations will be felt in any point of the surface of the sack. The sound waves move through the water and transfer movement energy to the surface of the sack. This means that also all water inside the sack has been vibrated. All water molecules inside the sack have been put in motion.

If we now put a human being in the place of the skin sack, the sound will move through the body - as if it was water - and we can feel the vibrations on the upper surface of the body. And - all cells inside the body have been vibrated by the sound waves which move through the body. We can look upon it this way : The body has received "internal massage". Thus organs in the body which we cannot reach by traditional methods - nerves, glands, lungs, heart, deep-lying blood vessels, brain tissue - will react when being exposed to sound vibrations. This is the basic idea of all Vibroacoustic therapy.

We all know that the body is exposed to sound massage. It is so common that we seldom give this fact a thought. When we speak or sing we produce sounds, and the vibrations from these sounds can be felt if we place our hands on the chest, back, larynx or the top of the skull of the person who is vocalizing. These vibrations are not dangerous for the human being. It even may be so that these vibrations are of vital importance for us, if we are to develop physically and mentally in a healthy way.

The same kinds of vibrations are transferred to the body during Vibroacoustic therapy. The only difference is that the source of sound is external, and that the sound sources are spread over a larger physical area. Thus all parts of the body can receive the same amount of vibrations simultaneously. Using loudspeakers and amplifiers, we also can regulate the amplitude of the sound, in order to obtain sounds which are weaker or stronger than the vibrations which can be produced inside our body. We also may regulate the pitch of the tones. In this way we can use the frequencies which we, empirically, have found have the most effective influence on certain defined conditions.

While we were in our mothers' wombs we were subject to a constant sound environment of ca 85 dB and we find the bulk of the intrauterine sounds in the area below 200 Hz. In Vibroacoustic therapy we do not exceed the "natural" limit of 80 dB.

This is the optimal environment for foetal development, floating in the amniotic fluid, well protected. The amniotic fluid transfers the sound vibrations to the entire body surface of the unborn child. These vibrations are in turn transferred to all internal cells of the child by normal sound conduction.

There is no evidence that such sound vibrations are not just as beneficial for grown-ups as they are for unborn children.

We are daily subject to stress which we cannot let loose in a natural way. Our body prepares for danger when it is subject to stress. This means that stress-hormones are pumped into the blood-stream, and the body prepares for physical activity : Fight or flee! The blood is filled with substances which makes it possible to exert a powerful burst of energy. In most situations this burst will be suppressed - it does not suit a civilized being to react in this way - and our body is left with unused and caged reserves of energy. These traces of stress will be stored as waste products in cells and blood vessels. This may, in time, lead to serious consequences for our health.

We know that the best way of loosening particles from a carpet is to shake it, or to beat it. It seems difficult to shake or "beat" the cells in our body or the arterial walls in the brain and coronary arteries. If we return to the image of the body being a skin sack receiving sound waves, we remember that each and every cell in the body receives massage by being exposed to low frequency sound vibrations from the Vibroacoustic equipment.

Vibrations which are strong enough to be felt by our fingertips are so powerful on cellular level that they are directly comparable to the beating of the rug.

The cell can be looked upon as a closed vessel, filled with liquid. When we shake this vessel, the contents of the vessel will be re-positioned. The cell membrane is not completely tight, however, and the mild, internal massage which Vibroacoustic therapy is giving. makes it possible for metabolic waste products to be expelled from the cell. The escape of these waste products from the cells would ordinarily take very long time.

The metabolic waste products will mix with the liquid which surrounds every cell. This liquid carries the waste products onwards through the lymphatic system, the blood system or through the cerebro-spinal fluid (CSF) for normal excretion from the body ( urine, faeces, transpiration etc.).

Many of the metabolic waste products are results of physiological stress reactions which have not got the possibility to be spent by physical activity. We can here see how Vibroacoustic therapy can contribute to remove some of the physiological effects of stress from our body by substituting "normal" vibrations with sound vibrations having approximately the same effect as "normal" vibrations.

DESCRIPTION OF EQUIPMENT.

The equipment consists of:

1. Vibroacoustic therapy programs from Olav Skille

2. Vibroacoustic chair/bed with built-in loudspeakers which provide sound

directly to 1. Neck/shoulders

2. Lower lumbar area

3. Thighs/seat

4. Calves

3. Vibroacoustic signal unit with 6 channels, whereof 4 are giving sounds

to the 4 sites described under # 2. The signal unit has got individual

control of amplitude for the sound going out to the 4 sites, master

volume control and a control unit monitoring the mixture of low

frequency massage signals and music. There is also a separate output

for headphones with its own volume control.

The hardware was produced by VibroAcoustics a/s, Norway.

TREATMENT PROCEDURE

SETTING CONTROLS

1. Always start with all controls in 0 (minimum) position.

Vibro-mix control at MINIMUM amplitude. - Depending on which recording

method which is used one obtains minimum amplitude by turning the vibro-

mix control fully to right or left. (Check by using your own ear and

touch).

NB ! This adjustment must be done by the therapist BEFORE the client is placed in the chair/bed.

2. Adjust the VOLUME-control to 2-3, and push the control for LEG upwards

until the client feels a pleasant and comfortable vibration and sound. Push the control for NECK upwards until the client feels a pleasant and

comfortable vibration and sound.

Push the control for THIGHS/SEAT upwards until the client feels a

pleasant and comfortable vibration and sound.

Push the control for BACK upwards until the client feels a

pleasant and comfortable vibration and sound.

3. When the profile controls have been individually adjusted, the VOLUME

CONTROL is adjusted so that the therapist and client cooperate in

deciding the level of the most comfortable general sound and vibration

level.

4. If the client wants more treble sound (music) blended into the pulsating

bass vibrations, the VIBRO-MIX CONTROL is turned more towards right (or

left - according to the recording method which has been used) until the

optimal sound quality is obtained.

5. When the most pleasant sound level has been found, the VOLUME CONTROL is

reduced by one unit.

6. The client is now left for him/herself for the duration of the therapy

tape. The therapist observes the client's reactions during the duration

of the session - without unduly disturbing the course of treatment.

CHOOSING THERAPY PROGRAMS

Basic principles for choosing frequencies:

When the therapist has obtained experience in using the equipment and feels safe about the effectivity of the different frequencies - and can plan his/her own therapeutic strategy, the choice of the therapist may make it necessary to use other frequency areas than the given Hz levels.

MAIN PRINCIPLES FOR CHOOSING THERAPEUTIC STRATEGY

1. Spasmolytic frequencies : 40 Hz and 60 Hz.

2. Low-back pains : 52 Hz.

35 Hz - 75 Hz is usually recommendable. Multi- frequency tapes

including frequencies in the 50 Hz area are also used.

4. Neck and shoulder pains : 68 Hz.

SOFTWARE

The standard tapes delivered with the chair/bed are just a small part of the therapy tapes used in therapy and research. Qualified therapists may contact VibroSoft a/s to get tapes specially made for specified conditions of use or for special research purposes.

It is necessary to have a representative and varied library of therapy tapes in order to be able to fulfil individual choice of music when the frequency areas to be used have been chosen. In some conditions the therapist ought to decide what kind of music which is to be used. This is especially important in cases of treating stress, or when one wants to obtain deep mental relaxation. In such cases the patient may have strong music preferences, but the effect of the therapy is in these cases dependant upon which kind of music which is used.

CHOOSING MUSIC

The low frequency sound pressure-waves are nursing the body, while the music is nursing the mind. Man consists of both of the two elements, and a complete treatment program must comprise both of them if the whole person is to be harmonized.

In Vibroacoustical contexts we have three categories of music to choose between. All three categories may be found in different musical keys, and it is therefore possible to choose between 36 main alternatives ( 3 categories - 12 keys) if all possibilities are to be covered once. The supply of music which can be used for therapeutic purposes is practically unlimited. The limiting factor is the capacity to make individually adapted therapy programs. It is therefore necessary to have a wide, standardized, supply of basic therapy software.

CATEGORY 1. MUSIC SPECIALLY MADE FOR VAT

This category music is specially made for Vibroacoustic therapy, and is based on one, single, frequency. This frequency is given to the composer, which uses this frequency as the basis for the composition. The composition consists of frequencies chosen from special mathematical relationships with the basic frequency. The harmonic mathematics are based on the natural scale.

When we then reduce the scale of over tones to one octave, we find the following table which is basic for all composition of fractal music. The laws of classical harmony are applied as guidelines for composing the structures of the music. The table can be used for any basic note, or frequency in any octave.

Table 1: Values for calculating harmonic Hz values from a basic value.

A = 440 Hz. (Natural A = 432 Hz)

In VAT music we seldom find melodic themes which can be followed by the client, even if the compositions are built over mathematical structures, which are repeated in different magnitudes. There will also be a clear and marked rhythm. The music therefore has a "floating" character. It is intended that the client not shall have any associations whatsoever to any kind of "known" music.

CATEGORY 2. RELAXATION MUSIC

Here we find music which is composed for relaxation when we listen to music in the normal, auditive way, The music is of a kind which suits very well for Vibroacoustic purposes. We therefore have added low frequency vibration to the compositions - as a "bottom layer" under the music. The frequency of this "bottom layer" is carefully tuned to the key of the musical composition in question, using the mathematical principles of fractal music.

Therapy tapes for VAT use must not be used for listening purposes. The reason for this is that the frequencies used are not made for listening only. The pure frequencies may also ruin standard Hi-Fi listening equipment if the tapes are used indiscriminately.

CATEGORY 3. "NORMAL" MUSIC - POPULAR MUSIC.

When the therapist is treating conditions, in which

a) choice of music category is secondary,

b) the client has very special music preferences which one wishes to please

or

c) the therapeutic strategy includes music which is intended to give

specific associations, or to give as much sensory, intellectual and

emotional stimulation as possible

it may be right to use "normal" music with the special Vibroacoustic frequencies added. Also when we use music of category 3 the choice of music is very important. The choice of strategy from the therapist's side, the client's choice of music, or use of music which we know has got some connection with the client's past must be considered when music is to be chosen.

One can use both classical music and popular music, but we mostly avoid the use of vocal music.

Therapy programs of category 2 and 3 are usually made on special orders. By sending ordinary music cassettes with ordinary music to:

and include a description of the client and the condition which is to be treated, the customized therapy tapes will be returned together with the original cassette.

It is important to state which frequency areas one wants covered. If it is musically possible, the tapes will include the frequencies in question.

MUSIC AND RELAXATION.

When we choose music of category 2 or 3 it is important to possess some facts around the choice of music which can be used for specific purposes.

Functional music is manipulative. We can find this in super-markets, waiting rooms or other places where people meet, and the owner of the area wants to obtain a specific effect in the audience.

If it is not counter indicated because of therapeutic strategy, it may be appropriate to create an atmosphere of warmth and security to calm a client filled with anxiety.

To obtain this effect we use special music, and in music medicine this music is called anxiolytic music.

Music therapy is considered to be a psychotherapeutic method, and has been used as such for around a century now. We have quite a lot of experience around the effects one can expect from listening to various musical compositions. Harm Willms has given a good summary of the empirical data collected on anxiolytic music:

Monotony can increase anxiety and produce a depressive mood. The therapist must therefore have a variety of musical material to choose from, so the patient will not be frustrated. Scientists who have been using classical music in their research around the effect of music (the pharmacology of music) have found the following basic principles for choosing anxiolytic music to be used in reception rooms:

-Solo-concertos are better than symphonies.

-Slow movements have the best effect: Andante, Adagio, Largo

-The choice of instruments is relevant. The best relaxing effect is found

in the oboe, then follow : piano, cello , violin, clarinet and organ.

-Song is usually to be avoided in connection with anxiety and relaxation.

-The choice of instruments ought to be varied in the different pieces of

music.

-There must be a pause of around 10 seconds between two pieces of music.

-The following keys are to be preferred: C-major, D-major, Bb-major and

F-major.

-Piano, harp and guitar can be played solo. The other instruments are

better suited in orchestral contexts.

It is not recommended to use such "anxiolytic music" only. There should be variations with music with faster tempi, a variety of timbre and instrumental combinations. Music from synthesizers can often satisfy all these conditions.

It is important to reduce the higher frequencies and to increase the lower frequencies in the music, in order to obtain a deeper physiological reduction of tensions.

Even if we do not work music therapeutically, it is possible within the frames of medical work to exploit the positive effects of music and sound to obtain:

Calmness

Relaxation

Deep relaxation

Psycho-somatic improvement.

In Vibroacoustic therapy music and sound vibrations are used as a physiotherapeutic remedy, in which the physiological characteristics of sound vibrations are important. This effect will come as an additive to the above mentioned effects of heard music.

In order to understand which physiological parameters one can find in clients with anxiety reactions, and how music can contribute to reduce physical tensions, it is of interest to study the following table over such reactions, made by the German doctors Roland Droh and Ralph Spintge.

PHYSIOLOGICAL ANXIETY REACTIONS

From Spintge/Droh : Anxiolytische Musik in der Operations-

vorbereitung. (Musik + Medizin, 2.81)

The choice of music is complicated. One has to take into consideration the personalities of both the client and the therapist. It is, ultimately, the therapist who decides which kind of music will be used, and the choice depends on the therapist's frame of reference and supply of therapy tapes.

The client will usually reject music which is completely out of harmony for the therapist's personality.

Monotony may increase anxiety and may produce depression. It is therefore important to have a wide and varied choice of therapy cassettes. One should not use "relaxation music" only. Variation between arrhythmic music and music with faster tempi should be considered. The same applies for music with changing timbre and instrumentation. Synthesizer music may in many cases satisfy all these considerations.

It is important to reduce the higher frequencies and to amplify the low frequencies in the music, in order to obtain deeper physiological relaxation.

PHYSIOLOGICAL EFFECTS OF ANXIOLYTIC MUSIC.

From Spintge/Droh : Anxiolytische Musik in der Operations-

vorbereitung. (Musik + Medizin, 2.81)

BASIC PRINCIPLES FOR VIBROACOUSTIC THERAPY

Vibroacoustic therapy is based on the three universal principles which were defined by Olav Skille and Juliette Alvin, in 1968:

1. Low frequencies can relax.

2. Rhythmical music can invigorate.

3. Loud music can create aggression

and - of course - the opposites of these universals may create the opposite effects.

These universals are a good guide when the therapeutic strategy is to be chosen.

It is, however, important to note that all frequencies used for the sound pressure waves of Vibroacoustic therapy are low in relation to Universal

# 1. These low frequencies may be closely adapted to the needs of the client. All universals must be taken into consideration when choosing music for the client.

It is important to remember that we are used to look upon music as being something which is concerning the ear only. Vibroacoustic therapy is aimed mainly at the body. Although we hear the sound pressure waves, they primarily have direct effect on muscles, glands and nervous system.

The common knowledge about the influence of music on man is based on knowledge collected during many centuries. In Vibroacoustic therapy sound is perceived also by receptors which we usually not have been connecting with music and sound perception. The knowledge collected after more that 40.000 hours of using Vibroacoustic therapy has enabled us to find new possibilities to soothe physical and mental discomfort for periods of various duration.

SUMMARY

In Vibroacoustic therapy sound is transferred to the body via air, but the body is placed as near the sound source as possible. The sound waves are penetrating all body tissue, and the body absorbs about 2 % of the energy which is transferred to the body. Muscles and nervous tissue react to the massive and synchronous stimuli. Sound moves about 4,5 times faster in water than in air, and thus the sound stimulation is affecting the whole body simultaneously. There is no other instrument which to the same degree can synchronize nervous impulses in the body.

The energy which is entering the body influences certain transmitter substances. These substances are important factors in the reactions we can observe as the result of the therapy. The low frequency vibrations will - among other reactions - often make the client drowsy. This can be used directly as a treatment for insomnia.

The body absorbs energy from the sound waves. This energy absorbtion gives heat to muscle tissue. The mechanical vibrations increase the blood flow in the extremities. The emotional effect of the music is enhancing these reactions. As a result we see reduced muscular tension and increased awareness of body reactions.

BASIC PRINCIPLES FOR CHOOSING FREQUENCIES AND MUSIC.

RESULTS OF VIBROACOUSTIC THERAPY

COUNTER INDICATIONS

Before using VibroAcoustic equipment on yourself or any other person, you should take advice from a doctor

- when suffering from recently prolapsed invertebral disc

- after an accident e.g. when suffering from head or neck injuries f.

ex. Whiplash injuries.

If there is any doubt that any of these conditions may be present, a doctor must be consulted before the treatment is commenced.

It is recommended that VA-equipment should be used by persons who have an educational background in medicine, para-medicine or a therapeutic field.

If VA equipment is used for personal purposes only, it is the responsibility of the sales-organization to inform the user about the safety rules, and to give proper instructions concerning use of the equipment and choice of programs.

Because of the above mentioned precautions, The International Society for VibroAcoustics (ISVA) has not, after 30.000 hours of use, received any reports concerning harmful effects of VibroAcoustic Therapy.

SYMPTOMS OF OVER-EXPOSURE

Over-exposure symptoms may appear if :

Over-exposure ( wrong frequency (frequencies) or music, too much volume used, too long time of exposure ) symptoms are:

In such cases one should not resume therapy until over-exposure symptoms have disappeared. It is possible to reduce or stop these symptoms if one gives the client a multi-frequency tape at least 4 hours after first exposure - or the next day.

If the client feels subjective uneasiness, therapy should be terminated for that day,- even if the therapy tape should be unfinished.

LOCATION OF SENSITIVITY AREAS FOR LOW FREQUENCIES.

Tony Wigram has conducted a study to verify the specifications of frequency sensitivity, which is basic for Vibroacoustic therapy. The frequency specifications given by Olav Skille have been found by empirical cooperation with patients. The main theory says that there is a proportionality between muscle size and frequency, so that low frequencies correspond with big muscle groups and the higher frequencies, the smaller muscle groups will respond.

Skille has found the given frequency areas by asking patients with different kind of pain symptoms and locations where they feel the most painful or relieving effect of frequencies while working within the Vibroacoustic range with frequency generators. When more that 10 persons with the same kind of symptoms, indepelnently reported relief from the same frequency area, a reference point had been made. Such reference points are given in this manual's survey of symptoms and therapeutic procedures.

The need for more precise studies in this field was apparent, as the potential value of "targeting" a frequency to specific areas wil give greater presribability to the use of VibroAcoustic therapy. Wigram's study was undertaken as a pilot study to test out the hypothesis that different frequencies are felt more strongly in different parts of the body.

39 subjects participated in the study, and they were subject to vibrations in the range between 20 Hz and 70 Hz. The procedure was standardized, and the subjects were to mark on a form in which of these parts of the body they felt the strongest sensations when exposed to a series of 9 frequencies: Feet, Calves, Thighs, Sacrum, Lumbar, Thoracic, Cervical, Shoulder and Head. The frequency areas used will appear in the succeeding tables. The subjects also were asked to note if they were not able to feel any focused sensations, but rather a general, all-over feeling of vibration.

Numbers of subjects reporting locations of a sensation of vibration.

At each frequency, a significant proportions of subjects felt a localised effect. There was a definite correlations between the frequency of 40 Hz and its effect on calves and thighs. 50 Hz also gave sensations, at a highly significant level, in thighs and sacrum. 60 Hz and 70 Hz showed a less significant localisation effect, and nine subjects felt an over-all effect at 70 Hz. Several subjects found the 20 Hz area unpleasant. The extremely low frequency area can provoke nausea, and should be avoided.

The study supports the theory that the body is receptive and resonant to individual frequencies. The study did not take in consideration the age, weight and height of the subject. The study was also carried out in healthy subjects, while the empirical work on Vibroacoustic therapy had been carried out in persons with localised pains and musculo-skeletal problems. There may be an important difference between frequency sensitivity in healthy tissues and in tissues afflicted with pains of various origins.

However, the study supports the growing evidence that the effect of definable frequency areas are specific and can be used specifically to focus on particular areas of the body. Further studies in this field are already under way.

This treatment is passive, and although it still requires a relationship between the therapist and client at the beginning and at the end, the therapeutic effect is generated from the combination of low frequencies and music alone, rather than by anything the therapist does. However, its potential is not only that of a treatment in itself, but also as combination therapy before, during or after other therapeutic procedures or interventions. There is already evidence that the nature of the relaxation that occurs is enormously valuable in preparing clients with muscular problems for subsequent physiotherapeutic treatment, and there is further evidence that clients with emotional problems and anxiety relax to the extent that they find it easy and often necessary to talk with the therapist after a treatment period.

CHOICE OF FREQUENCY AREAS AND CHOICE OF MUSIC, RELATED TO DIAGNOSES

The main frequency area for Vibroacoustic therapy lies in the octave between 40 Hz and 80 Hz. For some conditions, however, we have used frequencies above and under this octave. Therapy programs can be made from 35 Hz to 120 Hz.

Choice of music : All 3 categories can be used

Result of therapy:

CASES

Frequencies: Multi-frequency tapes with great variation.

Choice of music : Stimulating music of category 2 or 3.

Result of therapy:

Result of therapy:

Choice of frequencies : 40 Hz +/- 10 %

Choice of music : Any music can be used, but preferably category 3 and 2.

Result of therapy:

See also : Aphasia, Spasticity, Cerebral Palsy, Coma

7. Cerebral Palsy

Choice of frequency: 40 Hz and 60 Hz

Choice of music: Music which is found pleasant by the client, and

therapy tapes may be made of the favourite music of the

client. Music of all 3 categories may be used.

Result of therapy:

Choice of frequencies : Basic area : 42 Hz +/- 10 %.

Choice of music: Music which is found pleasant by the client, and

therapy tapes may be made of the favourite music of the

client. Music of all 3 categories may be used.

Result of therapy

Choice of frequencies: The most effective areas seem to be 40 Hz - 45 Hz

and 50 Hz - 56 Hz.

Choice of music: Music of all 3 categories can be used as long as the

character of music gives relaxation. For children, the use of

children's songs may be appropriate.

Result of therapy:

Choice of frequencies: Low frequencies with high frequencies for contrast effect.

Choice of music: Category 3 or 2. Contrasts between lively music and

relaxation music is desirable.

Result of therapy:

Choice of frequencies: Low frequencies in the 35 Hz - 45 Hz area.

Choice of music: All 3 categories can be used, but usually music in

Result of therapy:

If the natural processes start working again, the use of enemas can be considerably reduced.

NB: Diabetes must NOT be treated with Vibroacoustic equipment !

See : Menstrual pains

Choice of frequency: Frequencies in the 40 Hz area have been effective.

Choice of music: Category 1 or 2.

Result of therapy:

Double sessions

Result of therapy:

CASES

Choice of frequencies : 40 Hz +/- 10 %

Choice of music : Category 1 or 2

Result of therapy : Reduction of headache, muscular discomfort and muscle tensions.

Choice of frequencies: 1) 86 Hz

2) 68 Hz

3) 40 Hz and/or 60 Hz area.

Choice of music : Category 1 or 2

Result of therapy:

Choice of frequencies: Multi frequency tapes between 35 Hz and 48 Hz.

Choice of music: Category 1 or 2. (Some receptive clients also may sleep during music of category 3)

Choice of frequency : In the 3 cases 93 Hz was used.

Result of therapy: The clients were advised to drink as much as possible, and received therapy twice daily until the pains disappeared and the stones were got rid of the natural way (?). If no effect after 10 sessions, further attempts should be stopped.

Choice of frequencies : 52 Hz +/- 10 %

Choice of music: All 3 categories may be used.

Result of therapy: If Vibroacoustic therapy is effective, one will notice the effect already after the first or second session. Therapy is to be continued until the pain has stopped.

See also : Low back pains

Choice of music : Any of the 3 categories may be used.

Result of therapy:

Choice of frequency: 52 Hz

Choice of music: Category 1 or 2.

Result of therapy:

See also : Headache

Choice of frequency : High frequencies, usually over 80 Hz

Choice of music : Category 1 or 2. NB: Be careful with music loudness ! Do not use too high amplitude. This may make the attack worse.

Result of therapy : The chance of improving the condition is better the earlier the client is able to come for therapy when an attack is coming. Some clients may feel nauseous ( check against overexposure symptoms !) during treatment. Nausea will pass soon after session is over. Symptoms may disappear during the session, but the effect may also be delayed 1/2 - 1 hour after end of session. There usually will be some muscular tenderness in the neck/shoulder region left when the headache has disappeared.

NB : Migraine needs different frequencies than tension head-

ache.

Clients with Morbus Bechterew may usually expect reduction of the symptoms from stiff muscles in neck/shoulder/back.

Choice of music : Let the client choose music.

Optimal time for therapy session : In the afternoon.

Result of therapy:

Choice of frequency : The 40 Hz area seems to be most effective, but it is recommended to alternate with multi frequency therapy programs.

Choice of music: All 3 categories can be used. The choice is dependent of the general situation of the client.

Result of therapy :

Choice of frequency : 40 Hz and 60 Hz. ( +/- 10 % )

Choice of music : Whatever music which the client finds pleasant.

Result of therapy :

Choice of frequency : 68 Hz ( 40 Hz )

Choice of music : Preferably category 1 or 2. (Category 3 for energizing effect)

Result of therapy:

There has been reported reduction of oedema ( mainly in the extremities ) in elderly and/or institutionalized clients.

Result of therapy : In some cases reduction in oedematose condition has been reported.

Choice of frequencies: Low frequencies in the 35 Hz - 45 Hz area.

Choice of music: All 3 categories can be used, but usually music in

Result of therapy:

If the natural processes start working again, the use of enemas can be considerably reduced.

Choice of frequency : Preferably the 40 Hz area.

Choice of music : Category 2 or 1 are recommended.

Result of therapy:

Choice of frequencies : 35 Hz - 45 Hz.

Choice of music : Category 3 or 2. Let the client choose music category.

Result of therapy :

Result of therapy:

Choice of frequency: 52 Hz

Choice of music: Category 1 or 2.

Result of therapy:

Choice of frequencies : 40 Hz +/- 10 %

Choice of music : Any music can be used, but preferably category 3 and 2.

Result of therapy:

Choice of frequency : Frequencies under 60 Hz

Result of therapy :

Choice of frequency : Mainly frequencies in the 40 Hz area, but one should use multi-frequency tapes with elements from higher Hz areas.

Choice of music : Category 2 and 3.

Result of therapy :

Very notable spasmolytic effect has observed when Vibroacoustic therapy is combined with physiotherapy. It is important not to start therapy too intensely. This applies both to movement patterning and the amplitude used. Start with minimum loudness, and gradually increase amplitude until desired level has been reached. This may take several therapy sessions. If the amplitude is too strong, it is possible to provoke spasms.

Choice of frequency : 40 Hz area and 60 Hz area.

Result of therapy :

See also : Muscle cramps

Choice of frequency : From 34 Hz to 68 Hz. Use multi-frequency tapes.

Result of therapy:

4 CASES

Male, 26, soccer player. Had a knee operation 4 months ago. The knee was too inflexible and unstable to be used in active sport. Came to me just to "try something new". Traditional physiotherapy was impossible because of distance to nearest institute (200 km).

Using a base frequency of 40 Hz, I put together a program of 40-60-80-60-40 Hz sinusoidal tones. Each section lasted for about 5 minutes, totalling near 30 minutes.

The first 5 minutes were spent lying on the back on top of the sound sources while the sound could do the first effects. The next two sections were spent in the same position while the man himself bent and stretched the knee to maximum levels. The next two sections were spent in a knee-standing position where the bending and stretching exercises were actively made with full body weight. The knees were directly above the sound sources.

The last section was again spent lying on the back over the sound sources , for relaxation purposes. He was taught to use the equipment 2 - 3 times per week and repeat the procedure described above.

After 4 weeks of this procedure he felt that the treatment was not necessary any longer, and started active training and playing again.-

Male, 24, team-mate of case 1. Complaint : Stiff scar tissue after an operation in the knee about 1 year ago. He borrowed the cassette from his team-mate and started doing the same exercises as described in case 1.

5 weeks of therapy with irregular intervals - about 12 sessions in total - resulted in decrease of the discomfort , and made active sport situation less distressing for him.

Male,41, shopkeeper and week-end sportsman, competing in terrain running. He was competing on the highest district level. One Sunday he stepped over and strained the muscles in his calf and ankle. The condition was painful, and he was afraid that he would not be able to compete the following Sunday.

Two treatments of 30 min.,58 Hz, with one day between sessions showed considerable relief, and by Saturday the pains were totally gone. He was of the opinion that the healing process was accelerated by the VibroAcoustic treatment.

Male,21,member of the Finnish Ice-hockey National Team. Considerable pains after massive overdoses of training. Unable to participate in normal training this particular day because of intense pains in thighs and shoulder/neck. Came with his physiotherapist to try out the VibroAcoustic equipment. He got two consecutive treatments of each about 25 minutes, one program with frequencies in the 40 Hz area for the large muscles in his thighs , and one in the 60 Hz area for the muscles in his shoulder/neck. He fell asleep during treatment, which only consisted of lying on the back and letting the combination of music and sinusoidal tones do the job. The painful part of the body was placed directly over the sound sources.

He felt very relaxed after the two consecutive sessions, slept extremely well the following night, and was in full shape for a new training session the next morning, and the pains were gone.

He and the physiotherapist were astonished over the effectiveness of the therapy.

At the Polar Rally 1989 considerable attention was given to the effect of VA-therapy on sportsmen, when a driver with an acute stiff neck was treated. The condition was so dramatically improved that the Finnish Olympic committee now is starting to explore how to use VA-therapy in the psycho-physio relaxation of the team during intensive training periods.

See: Circulation, Head-ache, stress-depression

CASES

Choice of frequency : Basically : 68 Hz.

Result of therapy:

Choice of frequency : Adapted to the subjective feeling of physical discomfort. See : Basic frequencies.

Choice of music : Must be chosen according to the purpose of therapy. For relaxation purposes music of category 1 or 2 should be used. For invigorating purposes, stimulating music of category 3 must be chosen.

Result of therapy:

Choice of frequency : 35 Hz - 42 Hz.

Choice of music : Category 3 or 2.

Result of therapy:

Choice of frequency : Recent injury : 68 Hz +/- 10 %

Old, standing, pains : alternate between 40 Hz and

68 Hz ( +/- 10 % )

Choice of music : The music choice must be adapted to the mental condition of the client. Clients with secondary depressions must be given music which is adapted to their depression.

Result of therapy:

GENERAL CONSIDERATIONS:

Some effects are usual:

1. All loose the ability for time-orientation during the sessions.

2. The tones have a power which by far exceeds our mental defence

mechanisms.

3. Tendencies towards claustrophobia may occur.

4. In some, predisposed persons, anxiety and tendencies toward persecution

mania may occur.

Therapists using Vibroacoustic therapy must know these effects, and must be able to handle the situations which may arise. The best way to ensure this, is that the therapist has a solid professional background in related therapeutic areas.

It is important to note:

Olav Skille:

WHAT IS STRESS ?

Man's adaption to today's environment must be seen from an evolutionary point of view. The adaption is poor. It took us millions of years of development to become the species we are to-day, and in most of this time lapse the conditions for survival have been quite different than the conditions we meet to-day. The basic requisitions for the survival of our ancestors were mostly of physical nature. To-day's challenges are mostly of psychological nature. The physiological stress reactions - being influenced by the stress-hormones adrenaline, noradrenaline and cortisol - enabled our ancestors to be ready for physical efforts : Fight or flee! The psychological challenges of to-day will release the same stress-reactions, but we do not start the reactions which are designed to rid us of the stress-hormones : Physical action.

VibroAcoustic therapy can help us to reduce the effects of these "un-necessary" physical reactions in the same way as f. ex jogging is contributing to prevent the negative effects of stress. This "silent jogging" is also suitable for persons who, by any reason, are unable to use physical exercise as a stress-reducing procedure.

How are we influenced by stress-hormones? Do they help us to cope with the challenges we meet ? Are they threatening our health?

There is no simple answer to these questions, but we can say that stress-hormones are facilitating our adaption to the demands we meet, and that they are necessary for maintaining our capacity to cope with stress. But - in the long run the effects may be dangerous. An increasing number of research reports point out that frequent or long-lasting increase of the content of stress-hormones in the blood may lead to structural changes in the blood vessels. This may, in turn , contribute to increase the risk for coronary diseases.

Most of us are spending a large part of our adult life at our working place, and the work we do is influencing us in various ways. Rigid and supervised job situations give the greatest risk for high values of stress-hormones in our blood - caused by helplessness, reluctance and a feeling of being deserted. A job which permits control and possibility to influence the working process will, on the other side, be recognized as a positive challenge. People in such jobs usually ave a good health. They can exert influence on their own working situation in such a way that they achieve harmony between their own abilities and the demands they meet in their job. People who have no possibility to take initiative in their jobs often risk to be passive also in their free time.

The demands of the environment is received by the brain from our senses. The brain evaluates if we can meet the demands, and what level of alertness our body needs to cope with the task. Our body is more adapted to the life situation of our cave-dwelling ancestors than it is adapted to the modern society. Therefore we find that our stress-reactions often are more harmful than useful. Our brain is tuned in to reactions which are not socially acceptable in our civilized society.

The brain needs a certain amount of impressions from the environment in order to function well. Too little or too much input will disturb the brain centres which are responsible for our being awake. the "just right"-zone is varying from person to person. Unfortunately, many persons are forced to spend a large part of their lives outside of the zone, in which they might develop their potential to the optimal extent.

A person who reaches equilibrium between the demands from the environment and own abilities will not be hurt by stress. On the contrary - one will feel "glad stress" and satisfaction with one's work. If, however, the demands exceed the abilities , the equilibrium will be disturbed, and the stress will be felt as something unpleasant. One way to re-establish equilibrium may be to give the person education which will increase his professional qualifications. Another way is to give the person stimuli which enables the body to get rid of the waste products from the stressful situation. VibroAcoustic therapy is one method of giving such stimuli. -A combination of the two approaches will probably give the best results.

Control and influence over the job situation are key words concerning coping with high demands without exposing the body for too much wear and tear. Another important "buffer" is human support. Togetherness and support from other people can protect us against the harmful effects from stress.

VibroAcoustic therapy can give stimuli which both gives the body the possibility to rid itself of waste products and - through the conversation before and after each treatment - give human support to each client.

Individual treatment, using the equipment in connection with the health service at the working place, combined with discussion groups may also contribute to obtaining a good result.

We are all different, partly due to our genetic heritage and partly because of all our life-long experiences which influence us in various ways. There is, f. ex. a difference between the reactions of men and women to stress.

Mental exhaustion may increase the risks for catching a somatic disease, but we still do not know exactly which biological mechanisms which lie behind this phenomenon. The scientists agree, however, that there is a connection between stress and diseases such as myocardial infarction, hypertension, gastric ulcers, asthma and migraine. Our mental well-being and effectivity will be influenced. Understimulation makes us passive and we feel aversion and fatigue - which also may have effects on our free-time activities. An interesting job is often accompanied by a rich and active free-time life.

VibroAcoustic therapy - in combination with correct counselling - can contribute to dissolve problem-filled situations which, for the client in question, may appear to be locked.

The stone-age man has slowly evolved to be the man we find to-day through an environment which has been fairly constant through millions of years. It was important to be able to fight or to escape by fleeing when a danger was threatening. The body was prepared for a physical effort.

Man has, during the last centuries, changed our environment with an incredible speed by the help of technical development. The demands of to-day are more of mental than physical nature, but our body still reacts in the "stone-age way" when it interprets a situation as being dangerous,- but the body does not react accordingly.

The demands of our environment is processed in the cerebral cortex which sends signals to hypothalamus in the mid-brain.

Hypothalamus regulates many important functions, f.ex. temperature, liquid balance in the body and the intake of nutrition. From here the message is passed on to the glandulae suprarenales via two ways,- via the hypophysis cerebri to the suprarenal cortex and via the sympatic nervous system to the suprarenal medulla.

The hypophysis cerebri is a gland in the brain which regulates many other hormone-producing glands.

The sympatic nervous system is activated when one perceives a situation as being dangerous, and prepares the body for fight or escape.

The hypophysis cerebri emits hormones which stimulate the suprarenal cortex which is stimulated to excrete the stress.hormone cortisol which is carried out to the body via the blood-stream.

The suprarenal medulla consists of transformed nerve cells of the sympatic nervous system. Here adrenaline and noradrenaline are produced, which are spread to body tissue in order to prepare the body for fight. Noradrenaline is also excreted at the ends of the sympatic nerves.

Cortisol influences and stimulates the immune defense system and counteracts inflammations. Noradrenaline constricts the blood vessels and makes the blood pressure rise. Cortisol has an effect on the metabolism of carbohydrates, lipids and proteins in all body tissue.

Adrenaline decreases the supply of blood to the inner organs, f. ex. the digestive organs, and conducts blood to the muscles. Adrenaline increases the pulse and the performance capacity of the heart.

The capacity to choose between alternative ways of action is specific for the human being. We are able to plan in advance and to foresee the consequences of our actions and hold advantages and disadvantages up against each other. When we are using this ability manage to cope with stress, it may be that it is the "glad stress" which is prevailing.

The heavy stress comes when we are unable to choose by ourselves, but are passively forced to accept situations full of strain.

The main components in the feeling of stress are tension and discomfort. In our everyday life we often find the two simultaneously. There are situations in which tension can fill us with joy and satisfaction. In other situations the feeling of discomfort and failure get the upper hand, and we may just surrender.

The content of stress-hormones in the blood is influenced by these experiences. When we feel discomfort and helplessness, the contents of cortisol and adrenaline in the blood increase. When we feel positive tension, the level of adrenaline is increasing, while the level of cortisol is kept low. When we feel mental well-being we have a better chance to cope with strain without harming our health. This may be because the production of cortisol is resting. Cortisol is supposed so increase the sensitivity of the blood vessels for the harmful effects of adrenaline and noradrenaline.

In industry we find that much of such stress which comes from heavy and dirty tasks has disappeared after we began to use the new technology. But, when the work was made automatic and the human functions mainly consist of surveillance and control, different, but just as difficult, moments of stress may appear. The person who controls a process needs very seldom to take any action during normal circumstances, and the level of alertness decreases. At the same time, the operator must be alert and ready for immediate action. When a disturbance appears, the operator must change from passive surveillance routines to concrete actions. Both the understimulation and the overstimulation the operator is subject to in such situations increase the risk for incorrect actions. When incorrect actions lead to accidents, we call this "the human factor".

There is no simple recipe for obtaining satisfaction over one's work, but we know that control over one's own situation counteracts discomfort and increases the positive tension. When one is able to exert influence on one's own situation, we can define the best way of creating meaningful jobs.

This is typical for the grey every-day stress which many persons feel in their jobs. It is accompanied by high levels of adrenaline and cortisol in the blood. We find this type of stress in situations in which the persons are tied up and pressed to high productivity without capability to influence their own situation. This is typical for work at the production line or for monotonous supply of informations into computers - a "mental production line".

Very monotonous work has a tendency to "adhere" and not release its hold on the person after working hours. The work is also throwing its shadows over the free-time. Stress-hormones and blood pressure keep lying on an elevated level. Now it is time to kill the presumption that a monotonous working situation can be compensated by rich free-time activities. A job which restrains own initiative and denies the workers' insight and influence. makes them passive also in the free-time,- a kind of acquired helplessness. Stress may, besides being a burden in itself, create passivity and make it more difficult for the individual to change the conditions which create the stress - a vicious circle.

Stress-hormone reaction: Adrenaline increases much

Cortisol increases to some extent.

The cortisol and adrenaline levels increase. Here we find the heavy stress which is recognized by passivity and resignation. The wear and tear on the body may be greater during passivity than during the performance of drab and slow work. The unemployed are in the risk zone.

When one during a long period of time has had no possibility to change or influence one's situation, we may see a situation which we in psychological terms call "acquired helplessness". It is no use trying, and one becomes passive - even if the possibility for change is present. When one has learned this helplessness, it is very difficult to de-condition. It usually has a transfer-effect to other situations.

Stresshormone reaction: Adrenaline level increases somewhat

Cortisol level increases much

The content of stress-hormones is low, and we feel very much at ease. Periods with comfortable passivity enable us to collect new resources in front of the coming tasks. When one is rested and in good form, one has a more effective resistance against stress. It is f. ex. easier to relieve oneself from the strains of work after a vacation than it is just before the vacation.

Stresshormone-reaction: Adrenaline level decreases

Cortisol level decreases

Adrenaline level increases while the cortisol level is kept low. This makes the danger of increased adrenaline level less dangerous. Maybe it is the low level of cortisol during situations with high control one of the reasons why the risk for coronary infarction decreases when one has good control and influence over a very demanding job.

An especially interesting group of professionals in this context are conductors of symphony orchestras. They have an unusually tough and straining job and have high control of the result of their activity. Conductors usually live longer and have better health than other professional groups. Even among top level executives we can find this connection between glad stress and good health. They do not only succeed in keeping the stress within reasonable levels,- challenges make their creativity flourish, and the stress becomes a stimulus to new initiatives.

Stresshormone-reaction: Adrenaline level increases considerably

Cortisol level decreases considerably

When a man meets a challenge, he usually reacts with elevated adrenaline levels and increased blood pressure. His reaction may, as time goes by, imply a health risk.

The picture of the women is more diverse. Here we do not find the same connection between action and high adrenaline levels. A woman will usually manage to cope with the same mental activity as the man, without generating extra resources in the body. She is able to economize her resources better, while the old flight-or-flee-reaction is triggered in the male. The fact that women are coping with stress in a more economical way may be a contributive reason for the longer average life-span in women - averaging about 7 years.

The male role is strongly connected with the necessity to perform,- to show off for others. The female role is aimed towards relations between human beings and care for others. When the pattern of these roles is dissolved, more and more of us are becoming androgynous,- that is mentally bi-gendered. The androgynous man unifies "male" traits such as decisiveness and self-confidence with "female" traits such as care and empathy. In this broad spectrum, a new and versatile human role will be developed.

The androgynous human being ought to be well prepared to manage different kinds of demands. In to-day's society we can see tendencies pointing towards this androgynous role. Women conquer new professional areas which formerly have been dominated by men, while the men, in a somewhat slower tempo, move over to jobs which are considered to be female in character.

In a Swedish questionnaire on total work-load the participants reported how the division of responsibility for the various tasks in the household were divided. The result show that the division of responsibility mainly follow the traditional pattern of division between men and women. The women have the main responsibility for washing, ironing, shopping food, cooking, sewing and mending. The man takes responsibility for the main economy and the car.

There is a connection between the degree of stress at work and physiological reactions. In men the physiological reactions coincide with the degree of experienced stress.- the stronger feeling of stress, the higher blood pressure etc.

In women we do not fin this connection between the physical and the psychological situation,- their blood pressure does not rise when the feeling of stress increases.

There is connection between women's stress at work and the reactions in the evening after working hours. The reactions of women show a positive coincidence,. i.e. - their reactions at work have a transfer effect to their reactions in the evening. For the men this connection is low - or negative. In the men the stress-machinery goes in low gear (blood pressure and stress-hormones) even when they report that they have felt stress at work. The women bring their pressure at work with them to their homes. Maybe the stress-reactions of the body are reflecting the conflict between incompatible demands ?

Women often feel that the demands they meet at work are higher than the demands men meet. They have to achieve more in order to be accepted as equals. They feel lack of communication in the working situation and feel they have too little influence on the job they are doing. In addition to this come the demands from their after work duties, and this is the extra weight that makes the system go out of balance.

By giving support in different ways, the stress of the job can be reduced, thus giving both the worker and the employer possibility to cope with the demands in an active and effective way. Common for all supportive measurements is, however, that they are dependent on active measures - needing both time and/or money.

Workers who feel strong social support report far less feeling of stress than those with low social support.

It is special for women that social support reduces the feeling of stress.

Groups with weak social support show increased incidence of psychosomatic problems,- back pains and similar problems of movement, headache, mental problems, problems with heart, stomach and intestines.

Groups with strong social support report fewer of these psychosomatic difficulties.

Women over 40 years of age have markedly more psychosomatic problems than other groups of workers. Older women have more than twice as many symptoms as men and younger women. (Symptoms connected with menopause are not included in this comparison)

A possible way of showing support is to give the workers possibility to treat and/or prevent certain stress-reactions by offering possibility to receive VibroAcoustic therapy during working hours, or in the free-time - with support from the employer. The therapy can be given either by using equipment which is bought for the benefit of the workers by the employer, or by giving economical contributions for treatment at a physiotherapist or other registered therapist using this kind of equipment in their therapy.

The employer can, in this way give positive signals to the workers that the employer cares for the welfare and life quality of the employees, and that he is willing to invest in initiatives which may reduce the stress-reactions which will be accumulated during the day at work.

We are usually very conscious about questions concerning the physical and chemical environment around our jobs. We also know what can be done to fight noise, odours and heavy lifting operations. However, when it comes to our psycho-social environment, we meet big holes in our knowledge. The stress-factors are often invisible and difficult to define. We cannot quantify them, and therefore they are easily overlooked and underestimated. To begin building up buffers against stress is one way to start fighting this pollution factor in our working environment. We have started to recognize dynamic stress-buffers, such as social support and individual control. Such measures usually take a long time to carry out in effect, because we first have to analyze the various factors of the environment. This analysis must end in a plan for action, in which the workers also have to get involved in some way or other.

One measure which may have almost immediate effect, will be the acquisition of VibroAcoustic stress-fighting equipment, or that the employees (and leaders !) will be admitted to take part in active stress-prevention or stress-therapy during paid working hours - or paid stress-therapy in their own free-time. A combination of VibroAcoustic therapy and psychosocial stress-buffers is supposed to have the best effect.

This supposition is based on the KANSA-project, carried out in the insurance company KANSA in Helsinki, Finland by Petri Lehikoinen et al.

In 4 out of 5 stress-parameters it is found that VibroAcoustic therapy is more effective than internal support groups in the company. Both stress-reduction methods are effective, however.

This study shows that we, when the circumstances are favourable, may expect VibroAcoustic therapy to be a very effective method of fighting stress. One can expect a yearly reduction in absence from work around 1 - 2 % if we succeed in fighting the stress problems.

The psycho-social working environment and the health of the staff is something concerning us all, and ought to be the responsibility of every one of us. In order to get the best possible effect out of improvements in the psycho-social environment, everyone on the organisation; leaders on all levels, workers and trade union officials must have the necessary knowledge of stress-factors in order to participate in the work towards change.

It is important that all learn to understand the complex interplay between conditions at work, the total life situation and the individual capacity of each person.

It is necessary to give broad information and education on all levels in order to learn how to interpret early warning signals, and on this early level start preventive action in order to avoid harmful stress.

Arbetsmiljöfonden (Sweden) : Stress, hälsa, arbetsglädje.

Sammanfattning av forskningsprojekt om stress

och psykosocial arbetsmiljö ledda av Marianne

Frankenhaeuser.

Lehikoinen, Petri : The KANSA project.

Manuscript, Helsinki 1988.

Skille, Olav : VibroAcoustic research and treatment

procedures.

Manuscript, Steinkjer 1988.

Skille, Olav : Manual of VibroAcoustics.

Steinkjer 1986.

---------------------------------------------

Olav Skille:

A SURVEY OVER LITERATURE ON THE PHYSIOLOGICAL EFFECT OF MUSIC LISTENING.

Vibroacoustic therapy is comparatively new, and there have been few controlled research projects on the effects of body-perceived sound on the physiological processes in man. There must, however, be a considerable correlation between the effects of heard music and felt music. The only difference seems to be that Vibroacoustic perception of music will increase the effects which have been observed around music listening.

It is therefore possible to use the results from research made on the effects of auditively perceived music as a guideline for the effects we can expect to find as a consequence of Vibroacoustic therapy.

According to Benenzon, we can expect the following physiological effects of listening to music:

-Muscular energy is increased or reduced, according to the music used.

-Respiration rate will increase, or change its regularity

-One can see a marked, but varying, effect on pulse, blood pressure and

endocrine functions.

-The effect of sensory stimuli will be reduced in several ways.

-Fatigue will be reduced or delayed, and the hardening of muscles is

consequently increased

-Voluntary activity, such as typing etc. is increased, and the muscular

reflexes used in writing, drawing etc. are lengthened

-One can see changes in the electrical conductivity of the body

-One can see changes in metabolism and the biosynthesis of various

enzymatic processes may be influenced.

Benenzon looks upon music therapy as a psychotherapeutic method, and in his book we do not find descriptions of therapeutic procedures which were aimed at changing physiological processes.

Also in most other works there are descriptions of measured effects, but no methodical descriptions of how to use the measured effects to obtain specific therapeutic goals. Exceptions are found in dentistry and anaesthetics. In these areas doctors are using auditive perception for analgetic, anxiolytic and relaxing purposes.

Disserens and Fine find that it is reasonably clear that music has on occasions increased the body metabolism of certain people and has affected their muscular energy, respiration and/or circulation. ("Music..increases body metabolism..increases or decreases muscular energy..accelerates respiration and decreases its regularity..produces marked, but variable effects on volume, pulse and blood pressure..lowers the threshold for sensory stimuli of different modes..increases the internal secretion.")

Sears has found a clearer effect on muscular tensions in non-musicians that in musicians. The effect was clearer in women than in men. Muscle tone was in these experiments used as a parameter for emotional receptibility.

The physiological effect of music is dependant on the kind of music which is used. Miles & Tilly have shown that changes in tempi have the greatest effect on the respiration frequency.

The tempo factor also has an influence on changes in blood circulation.

When a person is lying, listening to music, and the rhythm of the music has a certain proportion to the breathing rhythm, the person can feel sensations much like sleep and trance.

The trance-like sleep is characteristic for the observations which have been made during tests concerning Vibroacoustic therapy and sleep,insomnia and reduction of tension.

Pontvik has found that music influences the psychophysiological tonus. He has found that it is important that the choice of music is right and that the sound source is placed at Solar Plexus level. Calming music has a sympaticolytic effect on the vegetative nervous system. Exiting music will usually have the opposite effect.

Destunis and Sebant and Jaedicke are emphasizing the relaxing effect of music on vegetative- neurotic spasms.

Savil , Gaertner and Blanke describe clear connections between musical influence and changes in pulse and blood pressure.

Harrer and Harrer have defined some principles for the mutual influence of music, emotions and the vegetative functions of the organism:

L.C. Muskatevc writes that "music has become an integrated part of our daily life, as natural as the air we breathe. Unfortunately - because of this self-evidence, its subtility is not noticed by others than the most sensitive and aware therapists. One ought to appreciate the refined and definable changes of behaviour which happen within the framework of musical experience. Music has none of the harsh, blunt and painful brutality which we find in less sophisticated diagnostic procedures.."

There are many projects describing the effect of certain forms of musical stimuli on transpiration. Using the electrical conductivity of the skin surface, and its changes when the skin is moistened by transpiration, we have a measurable indication on the emotional influence of music on man.

Respiration

A well controlled experiment by Ellis & Brighouse show that it is possible to influence respiration rate with certain forms of musical stimuli. The big individual differences and lack of correlation between the individual persons' reactions to different pieces of music, show us that the reactions are very specific and are dependent on person and music.

Pulse frequency

Ellis & Brighouse also investigated the influence of music on pulse rate. The results showed that there was a tendency towards an increase of pulse during musical influence. The results were not statistically significant. Other reports show the same inconsistency of reactions. One must therefore say that music has a marked, but variable, effect on pulse rate.

Pain sensitivity

Gardner et al. conducted a study on 1000 dental patients who could listen to a mixture of noise and music instead of getting anaesthesia. They were able to mix music and noise at will, and were asked to increase the volume when they felt or expected pain.

In 65 % there was no experience of pain, in 25 % some pain while 10 % had no effect of the auditive stimulation. One could see that music had a relaxing effect, and that noise could reduce pain. Some patients claimed that they did not feel anything, while some said that they were aware of the pain, but "it did not hurt".

In this experiment both music and noise were used, and one could only perceive the music when concentration was maximal. Such limitation of awareness seems to function in such a way that other stimuli will not be perceived.

According to Hernández-Peón et al a release of electrical activity in one sensory path always combined with a blocking of sensory transmission in other afferent paths. This phenomenon alternates in the different sensory systems from one moment to another.

Illing & Benedict state that reduced or raised blood pressure, respiration frequency, metabolism and muscular tension are physiological effects of music. The psychological effects are change of mood, increased awareness and increased receptibility for other forms of therapy. Music can penetrate serious mental blocks in the patients.

Destunis & Seebandt refer to a wide research project in the old DDR which gives a good picture of what already has been done of basic research around the physiological effects of music on the listener. The conditions are still object for research. The methodological thoroughness by which their projects was conducted deserves attention, and may serve as a guideline also for projects of to-day.

The investigations has to satisfy medical scientific and music scientific demands. The experiment group was therefore divided in two main groups in order to find:

To exclude as many disturbing sources as possible, optical, tactile, kinaesthetic, olfactory and temperature conditions were held constant.

The research team was aware that certain musical qualities not appear alone, but as parts of a whole musical structure. Therefore they had to differentiate between calming music and stimulating music.

To satisfy the scientific demands, it was necessary to divide the tested person in 7 sub-groups in order to take care of the variables presented under a).

In GROUP 1 one wanted primarily to study the effects of rhythmic influence.

In Strawinsky's "The rite of spring" rapid rise of blood pressure (BP) up to 24 mm Hg and an increase in pulse rate.

No patients were under 9 years of age. Young children did not show any vegetative changes because of the strange and un-understandable music.

Of the 17 patients, 3 did not show any increase in BP and 4 shoved no increase in pulse. With some degree of certainty one can say that a strong aggregation of rhythmical effects will bring vegetative changes when the patient is able to understand the music used.

The influence of tempo was to be investigated in GROUP 2. Here they found different results for calming and stimulating music.

While a broad Adagio and a more lively Allegretto did not show any differences - they both had a calming, almost sleep inducing effect - the stimulating effect of fast tempi (Presto and Allegro) was affirmed.

At the slow tempi one found reduction of blood pressure and pulse in almost all patients. At the fast tempi they found a stimulation of affections which usually was noticeable in increased pulse and blood pressure, and in 2 cases they also found ECG changes.

It is important to note that it was not only the fast tempo which was the only influencing factor. Also the frequent changes of tempo were found stimulating by the patients.

The observations in GROUP 3 investigated the influence of dynamics on the functions in medulla.

In the pieces which were supposed to be calming, the dynamic variations necessarily had to be limited to Pianissimo and Mezzoforte. At these levels pulse and blood pressure values kept their falling tendency. (13 of 15 patients fell after 10 to 15 minutes in a sleep-like state) A generally calming effect was observed in all patients, also in those who were very restless in the beginning.

By stimulating music it was interesting to see stronger reactions. Here the dominating influence of dynamics in the total musical course of action was demonstrated. The musical Fortissimo influenced any increase in pulse and blood pressure - including the ECG variations.

The strong dynamic variations in "The rite of spring" immediately were influencing the increase in pulse and blood pressure in the patients. Both values fell in connection with a reduction of and rose in connection with increase in dynamics. Dynamics must therefore be considered to be the most important factor in music therapy.

In the 4TH GROUP one investigated the problems around melodic structure, which makes it possible to compare melodic and atonal music. The lullaby in the calming music mainly was built over triad-based melodic lines and were increasing the need for sleep.

All patients, including the adults,- except an 18 year old female student - rejected the atonal melodies.

In the children there were no vegetative changes, even when they expressed dissatisfaction. In the adults the increase in pulse and blood pressure usually followed the expressed dissatisfaction.

For music therapy with children, a clear melodic structure must be preferred to an asymmetrically built melody. The team observed a clear increase in concentration ability in children when they met a clearly perceivable melodic structure,

GROUP 5 was exposed to the problems around timbre. This phenomenon must be seen in close connection with changes in melodic structure, as these two often appear simultaneously. (Here German and Rumanian folk music were used) The children rejected the music which was strange. Maybe the strange text made the music more difficult for the children. The same picture appeared when they used Chinese folk music.

However - the monotony of Eastern music gave a calming reaction, which was noticeable in minimal variations in pulse and blood pressure.

The children reacted uniformly on instrumental and vocal music, even if the children in school age liked vocal music better than instrumental music.

GROUP 6 was concentrated on the effect of harmony, which has a interrelationship with change in timbre. The harmonic extravagances of 20. century music influenced no vegetative changes in the children. This may be because children have a tendency only to accept phenomena which are known.

In adults the same music gave increased reaction values.

The problem around duration were investigated in GROUP 7. This parameter is of importance for any music therapeutical situation. In all participating patients who were treated several times, the calming effect was effective at an earlier point of tine the second and third therapy session than during the first. Certain shyness or anxiety reactions were influenced by the calming effect. When stimulating music was used, the effect of adaption can play a certain role, as the same patients after 10 minutes found that the dissonants were only half as unpleasant as the initial experience.

Slight increases in pulse and blood pressure usually accompanied these subjective statements.

The strongest reactions were found between 5 and 15 minutes during the therapy course, which totalled between 20 and 25 minutes.

Dr. med W. Tränkle has done some preliminary experiments on changes in reflector muscle tonus and musical experiences. He observed that the original "resting tonus" was reduced by 2,3 % , but could also be increased by up to 52 %. As far as his experiments can be used as a basis, one also can deduct that one may find an increase in after-effect with increasing age.

Music as sleep therapy is described by H. Wendt who says that "the connection between sleep therapy and music is..indirect. Just as much as for the other psychotherapeutic methods we are using (hypnosis, AT, cathartic methods, conversations etc.) we must suppose that music is harmonizing the cortical regulations which create improved readiness for sleep, because sleep is dependent on harmony of the cortical precesses."

Teirich did some work on the physiological effects of music, and he refers to Schumann who says : "Through music the affects are stimulated and through these, the vegetative system is influenced in such a way that a psychophysical experience of special character is evoked. Listening to music is no passive event, but is all the time creating physical resonances."

Revesz writes: "We here have the immediate effect of strong vibrations on the vasomotoric system. These are, in hearing people, to a certain degrees decisive for our changes in mood."

From these observations the question arose if not these phenomena also could be used therapeutically. Pontvik finds this possible, and expresses the wish that also the vibration senses ought to be included in the area of music and health. Pontvik tells about experiments in which he placed his patients on a cushion loudspeaker which was placed under the head or back.

His research in this field did not continue, as he continued his work in the acoustic area.

Teirich continued these experiments. The patient was lying on the couch after AT (Autogenous Training) and was told that the music he was to experience not only could be heard, but also could be felt in the extremities and the body. This lead to an increased feeling of heaviness and warmth,- which in this way could prolong the effect of AT.

Until June 1958 41 neurotic patients (mainly men) were treated in this way,- always after preceding AT. The patients reported satisfaction and dissatisfaction. Some patients felt anxiety during this treatment.

Teirich writes that he through his experiments seems to have proved that music has numerous therapeutical possibilities to offer; the vibrational experiences have special - hitherto un-noticed - tasks. "We psychiatrists see, increasingly often, anxiety and states of changed emotions of any kind; more seldom also unsoluble crises of life, which cannot be treated analytically, and mostly are treated with ataractics and sedatives. We will not here use as strong expressions as "total reorganisation of emotions","development of the orderly forces of emotional life" etc., but music therapy - used correctly has (carefully spoken) at least a palliative function. This is in it self sensible.

The effect usually stays considerably longer than one could expect. Help of this character ought to find its place alongside of the "psychopharmacology" which for the present is so much advertised by the chemical industry. To underestimate this will be a great mistake."

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Olav Skille, & Tony Wigram, RMT

VIBROACOUSTIC THERAPY

INTRODUCTION

There have been many exiting developments in the last two decades in the use in the use of sound and sound technology in treatment techniques. Although this is not a new concept, and history has thrown up evidence both in past civilisations and different cultures in the use of sound as a means of treating physical disabilities and pain, it is only in the latter part of this century that developments have occurred resulting in the use of such treatments as Ultrasound (Forster & Palastange 1985) and interferial therapy (Savage 1984), a form of low frequency electrical stimulus, and VibroAcoustic therapy.

At the same time that these developments were occurring, the growth of music therapy as a form of treatment mainly concentrated on the use of music and musical improvisation in interactional work with communication disabled people. It has been by the building of a relationship through music by means of musical interaction that music therapists have been able to demonstrate breakthroughs in achieving both physical, emotional and cognitive response from people who had seemed inaccessible to other forms of intervention. This was evident in the work of Juliette Alvin (1975,1976,1978) and Nordoff & Robins (1971,1977) with handicapped children and adults, and subsequently by many music therapists trained in these approaches in England and other countries.

Internationally, in America, South America, Europe, Canada and Australia, although approaches have differed in terms of the means of developing interaction with clients through music, the ethos that music therapy is a process involving the perceptual, cognitive and intellectual response of individuals to music has been common. However, it has also been realised that whereas music achieves an intellectual response when listened to, music and sound also cause a significant and frequently measurable physical response when sound waves enter the body. The appreciation of music, and the emotional impact of a particular piece of music may also stimulate a physical reaction - it may be one of elation or depression, sadness or happiness.

The components of a sound or a combination of sounds, in particular their pitch, volume and timbre will have a significant physiological and biochemical effect on the body. Muscular energy will increase or decrease depending on the rhythm, and breathing will accelerate or change its regularity. Fatigue can be reduced or induced and voluntary activity may be increased. In addition, a marked, but variable, effect on heart rate, blood pressure and endocrine functions is produced, and changes in metabolism and the biosynthesis of various enzymatic prosesses may be induced. These and further physiological reactions to sound and music were investigated and summarised by Dr. R. Benenzon, a music therapist and psychiatrist working in Argentina (Benenzon, 1981). Similar investigations are described in the proceedings of the 2nd international seminar for VibroAcoustics. (Skille, O. (ed) 1989)

In considering the effect of music and the elements that make up music, and in fully understanding the processes involved in music therapy, the physiological effect of sound on the body should be taken into consideration. Juliette Alvin once pointed out that she had to learn about the physiological effect of sound, and she commented that although most music therapists consider the emotional and psychological responses, the physiological reaction to sound is just as significant and often ignored.

As sound therefore can be seen to have a significant effect both biologically and physically, further investigation has been going on as to how sinusoidal low frequency tones can be used in the treatment process. Physical problems presented to a music therapist working with cerebral palsied clients will often include flexor or extensor muscle spasm, and the dichotomy in a treatment process involving interactional work is that whereas one can see a development in the responsiveness of the individual to the therapist, the increased level of activity will often stimulate a spasm.

Looking at ways of reducing the high muscle tone created by this spasm, there is a considerable body of evidence on the effect of mechanical vibration (Stilman 1970, Carrington 1980) where a motor within an object or on a base unit will set up a physical vibration that is indiscriminate in terms of frequency. In the early 1980s, one began to look at the effects of low frequency sound on high muscle tone and spasticity. The idea of using pure tones at a low frequency has been known in primitive cultures for thousands of years, and sounds and instruments were used to treat psychosomatic disorders.(In shamanistic cultures, the physical vibrations were often used). With more specific problems in mind, the possibility arose of finding a specific range of frequencies that could be coupled with relaxing, unrhythmic music to produce an effect directly into the body of physically handicapped people. (Skille 1982,1982,1985)

The first attempts in using vibroacoustic therapy were conducted in Norway in 1980. The method was then tentatively named the "Music Bath" and "low frequency sound massage". The Music Bath is trying to create an environment whereby the body is "bathed" in sound and vibration. During 1981/2, several test units were built in Norway, where there are about forty units at present in daily use.

Further developments since have led to research projects in Finland, England, Germany and Estonia. The process of vibroacoustic therapy was described at the first International Symposium for Music in Medicine in Lüdenscheid in 1982. The equipment (patented on a worldwide basis) consists of a bed/bench or chair with four to six built in loudspeakers. This is connected to a signal unit with six channels containing a cassette player which can run various tapes.

The process of vibroacoustic therapy involves lying a client on the bed so the sound is being transferred by air directly to the body of the client. Sound may also be transferred through a mattress or some means which can conduct the sound waves directly to the body. The body vibrates according to the different sound waves, and about 2% of the energy is absorbed by the client. (Swedish Defence Materiel Administration, 1985). As one might expect, the sound waves also have a substantial effect on the autonomic nervous system.

The vibroacoustic bed seems to have much in common with the instruments used by Pontvik and Teirich in the late '50s. Teirich is referring Katz and Revesz' description of the sensations when merely listening to music is replaced by transferring the same stimuli directly to the body: "one becomes conscious of a remarkable change of attitude, a change from within. While a musical tone is always subject to localisation in the room, the vibration sensation is localised in the body. One could say that the tones are pulled into the inner self, and they become closer to the physical I".

Alongside the development of the music bed, it was necessary to develop taped programmes that would be varied and effective in treating different problems. Cassette tapes were made up with a mixture of music and rhythmical pressure waves which are in harmonic relation to the music. A pulsed tone is created by placing two sinusoidal tones close together, i.e. 40 Hz and 40,5 Hz, and this rhythmical pressure wave is expected to cause a synchronisation of nervous impulses through the body, including the central nervous system.

This comprehensive stimulation contributes to a harmonisation of a body which has come out of phase with itself because of defects or traumas caused by external or internal conditions. Music has been written specially for this therapeutic process by several composers, among them the Finnish composer Otto Romanowski and the Norwegian composer Bjørn Sjøholt.

As far as the use of specific tones is concerned, subjective tests have indicated that the most significant frequencies range between 40 Hz and 80 Hz. The lower frequencies, 40 to 55 Hz will predominantly set up a resonant response in the lower lumbar region, pelvis, thighs and legs. As one moves up the frequency range, the sound is resonated in the upper chest, neck and head.

In March 1987 the first International Symposium for vibroacoustics was held in Norway. The Symposium was held to collect the experiences from users who had up to five years of experience with the equipment and method, and during the symposium more than 10,000 hours of use were placed on record. Most of the recorded use came from the work with multiply handicapped and mentally retarded clients of various ages. The reports were very positive, and identified the effectiveness of vibroacoustic therapy with a variety of problems ranging from rheumatoid conditions and muscle related problems to pulmonary disorders (Skille, 1987, Wigram & Weekes 1987)

Reports were made at this symposium by a variety of professional staff who had been using the equipment including music therapists, physiotherapists, nurses and teachers. They have been working within the parameters defined by Skille in earlier papers, and in the initial work Skille had done to define frequency areas which have the best influence on specific conditions or ailments as specified in the Manual of Vibroacoustics (Skille 1986). Since the Symposium, further work has been undertaken, specifically looking at the effectiveness of vibroacoustic therapy in many different areas and conditions.

In Norway, work was concentrated particularly on the benefit of treating people with muscle spasm, pain, stress or pulmonary conditions.

Low frequency sound waves have been found to have a spasmolytic effect. This property has been used in the treatment of children with cerebral palsy at the Health Centre Sonjatun and with the pre-school group at Fagerheim school; also at Moan School and Day Centre, Norway. Similarly, it has been used to reduce muscle spasm in patients at Lebenshilfe in Berlin, Germany and Harperbury Hospital, England. The central institution Ronni in Finland has also concluded a research project which confirms these observations. The head injuries unit at Sunnaas Hospital, Oslo, has been using vibroacoustic therapy to reduce spasms in their patients since September, 1986.

Users of vibroacoustic therapy consistently report relief of pain. A chief community nurse at Kåfjord, Norway, has treated patients with rheumatism, and at Sonjatun Health Centre, patients with polyarthritis, Morbus Bechterew and pulmonary emphysema have been treated since October 1986. All report decrease in pain. In cases which have an acute phase followed by periods of remission, e.g. rheumatoid arthritis, Morbus Bechterew in the acute stage, use of low frequency sound waves may cause an increase in pains.

It should therefore, be given in the non-inflammatory period and be avoided in the acute stages.

In Norway, TRILAX Centres have been started. In these Centres the clients are offered vibroacoustic therapy exclusively. The TRILAX Centres have treated more than 1000 patients since the beginning of 1988, and report relief of muscular pains, menstrual pains and PMT-syndrome. A case study report on treatment of functional dysmenhorrea was presented by Olav Skille at the 2nd. International Seminar arranged by the International Society for VibroAcoustics (ISVA). (Skille, 1989)

In treating sports injuries, one has found vibroacoustic therapy a useful method of relieving pains from muscular over-use, and that the rehabilitation period can be shortened considerably. One does not use this therapy if there is any internal or external bleeding (excluding menstrual bleeding).

It seems that vibroacoustic therapy is effective in treating most cases of mental or physical stress-reactions.

It has been noted many times, that people fall asleep while receiving vibroacoustic therapy and this effect has been used by the staff at the TRILAX Centres in Norway to treat insomnia and related problems. Patients report that after vibroacoustic therapy they find it easier to fall asleep at normal times and also that the duration of sleep is longer than they usually experience.

The gentle vibratory effect of low frequency sound waves on pulmonary tissue has been found to loosen lung secretions, and to reduce bronchial spasms, thus affording better gaseous exchange in patients with asthma, cystic fibrosis and bronchiectasis. Østerbo Central Institution and other institutions for multihandicapped mentally retarded patients considered whether the reductions they had noticed in minor chest infections in clients who were on vibroacoustic therapy programme was attributable to the treatment.

Following the Symposium in 1987, an experimental programme in the use of vibroacoustic therapy was set up in the Mental Handicap Unit of the North West Herts District Health Authority, in England. The Music Therapy Department, in collaboration with the Physiotherapy Department designed and built equipment which was then subsequently used with clients who had high muscle tone and spasm. The existing programmes had been developed using a combination of music and movement (Wigram and Weekes 1984), where an effective way had been found to treat cerebral palsy clients who had deteriorating problems due to flexor or extensor muscle spasm.

It seemed that the value of vibroacoustic therapy could be in reducing muscle tone to the extent where the maximum possible range of motion could be maintained and the onset of fixed deformities would be delayed still further.

There was additional anecdotal evidence from the work to date in Norway of the effects of low frequency sound in improving circulation. It was therefore decided to look more closely at another chronic condition in long-stay elderly patients who had chronic oedema in the lower limbs.

In approximately 380 treatments, carried out over a period January to December 1988, Wigram and Weekes found comparable results to the work to date in Norway.

With one client, there was a specific reduction in muscle spasm in the back, arm, trunk and legs. After the treatment sessions, the patient initiated spontaneous movement and after three treatments her respiration had improved and she was laughing during treatment.

Another patient, with very severe spasticity, showed a general reduction in her muscle spasm, and the worried expression on her face disappeared during the sessions. Her shoulders are much more relaxed and her chest movements have increased. Again the patient started spontaneous movements in her arms as a result of the reduction in muscle spasm. She also began vocalising in the sessions, and the extent of her relaxation is that she accommodates to the flat surface that she is lying on and rests her head for long periods of time. She began to flex and extend her legs where previously they were locked in spasm.

A third patient also had gross physical deformities, and a worried frown on her face because she was very anxious about being moved. She had been considered for a possible operation to release the soft tissues in her legs which are at present crossed due to her adductor spasm. During the course of her treatment, there has again been a general reduction in the muscle spasm with this patient. She has gross scoliosis and had rapid, distressed breathing, and the breathing became easier during the course of treatment.

A final example of the client group treated at Harperbury Hospital during the course of 1988 was an Ataxic lady with typical increased lumbar-lordosis and rigidity of her spine, who also had arthritic changes in the spine and knees. She was treated with a pillow under her head and under her knees in an attempt to make her comfortable on the vibro unit. After 10 minutes of vibroacoustic therapy she was smiling, and when she came for the second treatment she was very keen to go on the unit and smiled throughout the session. She was treated in the early morning, and at 6 p.m. she was still pain free. She coughed during the treatment due to the vibration loosening secretions and eliciting the cough reflex.

In looking at the effect of low frequency sound on rheumatism and rheumatoid arthritis, a lady was seen who had very painful joints, and whose hands were in splints. It was very difficult to seat her comfortably as she was very apprehensive about being lifted onto the vibro unit. She was made as comfortable as possible, using several pillows filled with polystyrene beads, and after ten minutes treatment she said she was feeling much more relaxed. After twenty minutes, her shoulders had relaxed and she was able to touch her own nose and was smiling. After three treatments it was easier to put her back in her chair because it was possible to bend her hips to 90 degrees and she was altogether more comfortable.

As a result of treating residents in the Hospital, the unit evoked interest in the staff. One Physiotherapist had a back problem with Sciatic nerve complications and was off work for five months having tried various forms of treatment. She tried the vibro-treatment, and is now better, but left with niggly pains in the Sciatic area. There was a significant improvement in the mobility of her back, and most important of all, she had a substantial reduction in pain.

Another member of staff had a history of Sacro-iliac strain. She is frequently required to undertake heavy lifting in the unit and had recently had an acute spell of pain. The sessions she had on the vibro unit gave her considerable relief, and she is now mobile and pain free.

There are other examples of minor problems such as neck strain, headaches, and small back pains that were alleviated with the vibro unit.

Methods of evaluating the effectiveness of vibroacoustic therapy have to date relied largely on subjective records and a considerable body of anecdotal evidence. Depending on the conditions that are being treated, more objective measures are now being used to give a reliable and valid measure of the short and long term effectiveness of this therapy.

Research projects are running in Norway, Finland, Estonia and England. Projects in Finland have looked at the value of vibroacoustic therapy as a means of reducing stress (Lehikoinen 1988). In Estonia, a psychiatric team is treating patients, mainly with neuroses, using the vibroacoustic method. (Saluveer & al. 1989)

A research programme has recently been concluded by Wigram and Weekes in England, looking at the reduction of muscle tone in cerebral palsy clients, and a single-blind test was used to evaluate the observations. Two separate frequencies were used of 40 Hz and 44 Hz. Treatments were carried out twice a week on twelve clients. Measurements were taken before and after treatment sessions by independent evaluators to monitor the range of movement in a variety of joints. The experiment was primarily concerned with monitoring the influence of low frequency sound, and the experiment was designed to look at a comparison of two different conditions. In the first condition the client would receive both music and a low frequency tone and in the second condition the client would receive only the music. The outcome of this experiment showed a more significant decrease in muscle tone when the low frequency was used than when music alone was used. All other variables were kept constant, and blood pressure and heart rate were additionally monitored. This particular research has shown a statistically very significant result in favour of the use of low frequency sound and this treatment process (Wigram and Weekes 1989).

Further research carried out by Wigram and Weekes concurrently looked at the effect of the treatment on clients who have oedema. Measurements were made on three clients who had oedematous legs, and in this instance the difference was small. However, the results did show a statistically significant improvement when low frequency sound was used, and the effective improvement in the circulation caused the shifting of fluids and a reduction in the size of the limbs. In real terms, however, the reduction was not great, and a comparison needs to be made between the use of low frequency tone as against the elevation of legs as a normal means of reducing oedema.

In conclusion, there is now an increasing body of evidence accumulating to support the efficacy of using low frequency sound and vibroacoustic therapy programmes to treat certain conditions. A fair comparison of the influence of low frequency sound should include evidence of all research in which low frequency sound has been used. In situations where people were exposed to low frequencies of considerable intensity, work was mainly undertaken to protect them from such frequencies. Further research was inevitably undertaken to look at the effect of low frequency sound on metal by the aircraft industry, and in more recent times research has been undertaken by the Defence Departments of NATO, which is highly classified and consequently unavailable. Mention of this is only made to highlight the variety of areas in which the effect of sound is being looked at, and the considerable influence and impact it has made on mankind.

It is, however, important to observe the difference of effects that has been observed in using the VibroAcoustic Principle in therapeutic procedures, and the effect of the same stimuli perceived only by auditive perception. It seems that the stimuli used by the use of the VibroAcoustic Principle (transmission of sound to the human body perceived through vibration receptors and auditive receptors as well as bioreceptors - giving the client whole-body sound vibration which virtually has an effect on every single cell in the body) can be compared with the sound/vibration environment which can be observed in the human uterus - an environment especially beneficial for the development of healthy functions. This sound/vibration environment seems to have a totally different effect on people than the effect we can observe when we look at the negative effect of long time exposure to low frequency sound and vibration which we can observe in certain sound/vibration-polluted conditions.

In the highly specialised area of music therapy, the use of free and atonal improvisation in a creative process aimed at developing a relationship through interaction with clients still relies on the fundamental principle that high frequencies have the effect of raising tension, whereas low frequencies have the effect of relaxing. Consequently the choice of equipment used in improvisation, the tone and timbre of the instruments and the way they are played, reflect much of the current treatment principles of vibroacoustic therapy. It can therefore be expected that in evaluating the efficacy of music therapy, consideration should be given to the physiological effect of the sounds.

In the meantime , there is a considerable amount of further exploration that is at present being planned and undertaken to define more clearly the effects of vibroacoustic therapy, and its value as a prescribable treatment.

REFERENCES

Alvin, J.(1975). Music Therapy (revised edition). London: John Clare Books.

Alvin, J.(1976). Music for the handicapped child (second edition). London: Oxford University Press.

Alvin, J.(1978). Music therapy for the autistic child. London: Oxford University Press.

Benenzon, R.O.(1981): Music Therapy Manual. Charles C. Thomas. Springfield Ill.

Carrington, M.E.: Vibration as a training tool for the profoundly multiply handicapped child within the family. Lecture given at Castle Priority College, January 1980.

Destunis & Sebrant: Beitrag zur Frage der Musikeinwirkung auf die zwischenhirngesteuerten Funktionen des Kindes. Teirich, H.(ed): Musik in der Medizin. Fischer Verlag. Stuttgart. 1958.

Forster, A. and Palastanga, N.(1985) Clayton's Electrotherapy Theory and Practise. Chapter V, 165-180. Balliere Tindall. London. Philadelphia.

Lehikoinen, Petri : The KANSA Project. Report from a controlled study on the effect of VibroAcoustical Therapy on stress. Unpublished paper 1988.

Lehikoinen, Petri : Ääniaaltojen rentouttava vaikutus.

Musikkiterapia no 1-2/1988 p. 21 - 25.

Nordoff, P. and Robbins, C. (1971) Therapy in music for handicapped children. London: Victor Gollancz Ltd.

Nordoff, P. and Robbins, C. (1977) Creative music therapy. New York: Harper & Row Publishers.

Pontvik, A.: Heilen durch Musik. Rascher Verlag, Zürich. 1955.

Saluveer,E, Tamm, S., Ojaperv. I.: The use of VibroAcoustic Therapy on 40 Psychiatric patients in the Dept. of Medicine, Tallinn Pedagogical Institute, USSR Estonia.

Paper read at 2nd International seminar on the use of VibroAcoustic Therapy, Steinkjer, 14.-16.4. 1989.

Savage, B. (1984). Interferential Therapy. Faber. London. Boston.

Sears, W.W.: The Effect of Music on Muscle Tonus. Music Therapy 1957. NAMT 1958 s. 199-205

Skille, O.: The Music Bath - Possible Use as an Anxiolytic

(in Spintge/Droh (eds) Music in Medicine. (Springer Verlag

1985))

Skille,O.: Low Frequency Sound Massage - The Music Bath -

A Follow-up Report. (in Spintge/Droh (eds) Music in Medicine

(Springer Verlag 1985))

Skille,O.(ed): Rapport fra symposium 13.-15. mars 1987.

(VibroSoft 1987 - limited edition)

Skille, O.: VibroAcoustics and sport - The beginning of a New Approach to Muscular Stress? (in Spintge/Droh (eds): Schmerz und Sport p. 150 -156. Springer Verlag 1988)

Skille, Olav : Fysmus - med en annen vri. Musikkterapi nr 3-4 1988 årg. 13, p. 48 - 63.

Skille, O.: Behandling av funksjonell dysmenhorrea med VibroAkustisk behandling. (VibroSoft, 1989)

Skille, O.: Samlerapport fra 2. internasjonale brukerseminar omkring VibroAkustisk behandling 14.-16.4. 1989. (VibroSoft 1989 Limited edition)

Swedish Defence Materiel Administration: INFRASOUND -

a summary of interesting articles, p. 33.(FMV:ELEKTRO A12:142

May 1985)

Teirich, H.: Musik im Rahmen einer nervenärtzlichen Praxis.

Musik in der Medizin, Fischer, Stuttgart, 1958.

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Olav Skille

VARIATIONS IN BLOOD PRESSURE AND PULSE DURING VIBROACOUSTIC TREATMENT. PILOT STUDY.

In TRILAX Centre, Steinkjer, routine measurements of Blood Pressure (BP) and Pulse (P) are done to evaluate the effect of treatment on the clients. A sample of 82 measurements show a marked, but varying effect on the measured functions. The medium values were : Syst. BP -4,34. Diast. BP -5,35. Pulse - 4,49.

The measured values are checked initially (A), after 5 min rest (B) and at termination of treatment (C). The variation of values A-B, B-C, and A-C are described.

TRILAX CENTRE, STEINKJER.

TRILAX Centre, Steinkjer, is a private centre to which clients are coming to receive VibroAcoustic therapy. The centre is not offering any other kind of treatment.

THE BASIS FOR THE STUDY.

In TRILAX Centre, Steinkjer, one has included measurement of Blood Pressure and Pulse in the standard procedure of client reception. Systolic blood pressure(SPB) and Diastolic blood pressure (DBP) and Pulse (P) are measured.

The study includes 82 randomly chosen measurements of patients coming for treatment during fall 1988. The all-over distribution of patients show 30% men and 70% women.

20-29 years : 6%. 30-39 years : 17%. 40-49 years : 16%..

50-59 years : 18%. 60-69 years : 20%. 70-79 years : 14%

80-89 years : 3%

A Digital Electronic Blood Pressure Monitor from Select a/s was used as measuring instrument.

THE THERAPY

VibroAcoustic Therapy gives the client whole-body excitation from sinusoidal, regularly pulsating, sound-pressure waves in the VibroAoustical area (30 Hz - 120 Hz). The frequencies are chosen according to the purpose of the treatment. The sound-pressure waves are mixed with music to soften the effect of pure machine-sound. The therapy has been developed by the author of this article.

The client is exposed to the therapeutic sound system sitting in a VibroAcoustic chair or lying in a VibroAcoustic bed in which sound-vibration impulse givers are built in covering the main exposure areas : Shoulder/Neck, Low Back, Thighs and Calves.

The equipment in use has been a MultiVib Chair VA 115 or a TRILAX Bed VB 555 and signal unit SU 225 from VibroAcoustics a/s. The therapy programs are made by VibroSoft a/s and are supplied on

ready-made C-60 cassette tapes. The music which is used to mask the low frequency signals is supplied by the composers Otto Romanowski, Finland and Svein Sjøholt, Norway. For research purposes other musical bases have also been used.

A therapy session normally lasts between 20 and 29 minutes.

RESULTS

SBP at arrival : m = 138,09 sd = 14,37

DBP at arrival : m = 86,72 sd = 7,69

P at arrival : m = 76,54 sd = 16,01

SBP after 5 minutes rest : m = 127,54 sd = 18,08

DBP after 5 minutes rest : m = 79,84 sd = 15,49

P after 5 minutes rest : m = 72,44 sd = 13,95

SBP after therapy session : m = 124,15 sd = 16,90

DBP after therapy session : m = 77,05 sd = 11,41

P after therapy session : m = 67,77 sd = 11,60

From N= 82 there was observed a SBP rise in 24 clients (29,3%) and a SBP fall in 57 clients (69,5%). Unchanged values in 1 client. In the whole group one found middle value (m) = -4,34 with standard deviation (sd) = 9,44.

Looking at the N=24 where a rising SPB was observed one observes m= +8,86 and sd= 10,58.

In the N= 57 where SBP was lowered, one finds m= -9,98 and sd= 7,65.

A rise in DBP was observed in 22 clients (26,8%) and a DBP fall in 58 clients (70,7%). Unchanged values in 2 clients.

From N= 82 one found m= -5,35 and sd=7,69.

In the N= 22 where a DBP rise was observed one finds m= +8,86 and sd= 10,58.

In the N= 57 where DBP was lowered one finds m= -9,09 and sd = 7,66.

A rise in P was observed in 18 clients (22,0%), and a falling P in 56 clients (68,3%). Unchanged in 8 clients.

From N= 82 the effect was m= -4,49 and sd 7,20.

In the N=18 where a P rise was observed one finds m= +4,78 and

sd = 4,16.

In the N= 56 where P was lowered one finds m= -8,43 and sd = 5,08.

In order to - in any case, partially - eliminate the effect of pure rest, the clients in step B - C were examined after 5 min rest. To demonstrate the effect of pure rest one has measured the effect of this rest by comparing SBP, DBP and P measured at arrival and after 5 min rest.

The client was placed in the chair/bed and the initial measures were taken. After 5 min the measuring process was repeated, and the therapy procedure started.

In the whole group one found that SBP rose in 16 clients (19,5%),

fell in 62 clients (75,6%) and was unchanged in 4 clients.

In the whole group N=82 one found m= -4,29 and sd = 9,44.

In the N= 16 where rising SBP was observed m= +7,06 and sd = 3,51.

In the N= 62 where a falling SBP was observed m= -12,74 and sd = 8,94.

In the whole group one found that DBP rose in 22 clients (26,8%), Fell in 55 clients (67,1%) and was unchanged in 5 clients.

In the whole group N= 82 one found m= -4,23 and sd = 10,67

In the N= 22 where rising DBP was observed m= +7,41 and sd = 7,73.

In the N= 55 where a falling DBP was observed m= -8,51 and sd = 9,92.

Effect on Pulse (BP)

P rose in 19 clients (23,2%), fell in 51 clients (62,2%) and was unchanged in 12 clients.

In the whole group N= 82 one found m= - 3,16 and sd = 7,18.

In the N= 19 where rising P was observed m= +5,32 and sd = 5,69

In the N= 51 where falling P was observed m= -7,14 and sd = 5,06

In order to - if possible - obtain data which can give a clearer explanation of the specific effect of VibroAcoustical therapy, one has included the extreme values - without compensating for the effect of 5 min rest, as done in table B - C.

SBP values rose in 12 clients (14,6%), fell in 67 clients (81,2%) and was unchanged in 3 clients.

In the whole group N= 82 m= -12,20 and sd = 12,94.

In the N= 12 where SBP rose, m= +8,33 and sd = 6.09.

In the N= 67 where SBP fell, m= -16,75 and sd = 9,35.

DBP values rose in 14 clients (17,1%), sank in 63 clients (76,8%) and was unchanged in 5 clients.

In the whole group N= 82 m= -7,98 and sd = 11,23.

In the N= 14 where DBP rose, m= +6,00 and sd = 7,69.

In the N= 63 where DBP fell, m= -11,38 and sd = 10,03.

P values rose in 13 patients (15,9%), fell in 67 clients (81,2%)

and were unchanged in 2 clients.

In the whole group N= 82 m=-7,40 and sd = 8,25

In the N= 13 where P rose, m= +5,46 and sd 5,84.

In the N= 67 where P fell, m= -9,87 med sd 5,54.

The statistical data the article is based upon are few, but many enough to give an indication of what effects one can expect on SBP,DBP and P as a consequence of exposition to VibroAcoustical Therapy.

The results cannot be directly compared with other studies dealing with the effect of rest on SBP,DBP and P, as all persons were exposed to VibroAcoustic stimuli in the rest period.

It is difficult to predict the described effects in a patient.

Patients who react to the therapy with a rise in the measured parameters have the same subjective feeling of stress-reduction, muscular relaxation and well-being after end of therapy session as patients in whom the same values are falling. The rise in values therefore have no correlation with physical discomfort.

It is a ca. 75% probability for a fall in SBP,DBP and P values in a patient who is exposed to VibroAcoustic Therapy. A patient cannot be expected to show the same direction of effect during repeated treatments. The mean values of the above mentioned parameters are respectively -4,34 and -5,35 mm Hg and -4,49 beats/sec.

The effects of VibroAcoustic Therapy on the vegetative nervous system is demonstrated, but the inter- and intrapersonal variations observed are too unstable to justify the use of VibroAcoustic therapy as a specific therapy for anomalies in SBP, DBP and P.

This pilot study has not taken into consideration the effect of the various software tapes which were used. In the next phase of the research project around the effect of VibroAcoustic therapy

on Blood Pressure and Pulse, one should try to find if there are certain software tapes which induce changes in the measured values in one or the other direction more than other tapes.

Positive identification of such software will make it possible to produce therapy programs which will have an increased degree of predictable effects on SBP, DBP and P compared with the programs used in this study.

SPITALUL MUNICIPAL ONESTI

Str. Perchiu nr. 1

COD 5450

JUD. BACAU

Rumania

In respect to the sedative effects and decontracturing effects of the VibroAcoustic armchair emphasized in the technical book, we have used it for 40 patients who were suffering from lumbar regional pains with antalgic limitation of flexion movements and with paravertebral lumbar muscle contracture in different degrees.

The symptoms appeared in 75 % of the patients from big and long physical efforts, and in the remaining 25 % of the patients they appeared after cold exposure. From 40 patients, 25 were male (62,5 %) and 15 women (37,5 %).

The patients' age was between 25 and 59 years, as it follows:

25 - 35 years 8 patients 20 %

45 - 55 years 6 patients 15 %

> 55 years 2 patients 5 %

For these patients we have used the frequency tape 69 - 46 - 52 Hz during 10 minutes in 6 subsequent sessions. During the whole treatment period we monitored the blood pressure, the decrease of muscle contractures and the decrease of pain intensity. Before starting the treatment the patients were referred to a cardiologist. None of them had arterial hypertension.

Following the treatment, the blood pressure could decrease by over 5 mm Hg with an average of 3 mm Hg.

In approximately 85 % of the patients the muscle contracture disappeared. In 5 % we have got significant improvements and in only 10 % the contracture was not influenced.

Concerning the pain, in 75 % of the patients it was completely relieved, in 15 % of the patients it decreased significantly and in 10 % of the patients the result was less satisfactory.

In 10 patients treated we combined VA treatment with dyadynamic currents in the formula PL₄ DF₂ applied before the VA treatment. Here we had very good result even after 4 sessions.

Looking back on our experience, our opinion of VA treatment is : The VibroAcoustic therapy gives very good results in the field of muscle contracture. For the future our aim is to use the VA armchair in different patients groups, to study the results, and to send the results to you.

DR. VIORIL PAVALOAIE (sign)

Head of physiotherapy service

(This report is included by courtesy of VibroAcoustics a/s)

...............................................

Excerpts from ENGLISH SUMMARY of 1st Vibroacoustic symposium 1987.

by TONY WIGRAM and LYN WEEKES

REPORT ON A TWO-DAY CONFERENCE AT LEVANGER (TRONDHEIM) NORWAY

13th - 15th March 1987

Lund reported on work he has been evaluating to quadriplegi cerebral palsied children. He identified the cause of spasms as follows:

1. Physical - reaction to movement.

2. Pain - causing the same reaction.

3. Psychic causes.

Spasm can be a defense mechanism against external stimuli. One of the consequences of the spasms is pain, and it can be caused by too much lactic acid in the muscle. The way to avoid pain is to work with the client more and pump out metabolic waste products from the muscles. However, pain leads to more spasms which leads to more pain, creating a vicious circle. The circle can only be broken by diminishing or loosing the spasms.

General approach:

Lund is developing a team approach involving music therapy, audiology and physiotherapy. He believes in using the music bath in conjunction with a programme of movement. He uses traditional music and begins by preparing the patient orally for what is to happen. He starts with the music coming out of the speaker and gradually moves it into the "music bed" in which the patient is lying.

Generally speaking he was using movements much along the lines described in the paper "Music and Movement" (Wigram and Weekes 1983). He is also using music and the Vibro-Acoustic system in a behavioural approach - i.e. stopping hand to mouth movements. Although he found he could stop hand to mouth movements through withdrawing and the stimuli, he felt it was necessary to put something in their place.

Generally speaking, the clients he works with had this therapy twice a week. He has found that the effect last longer that the session itself.

THE MUSIC CONTENT.

Lund has found that using rhythmical, very basic music has a negative and a stressful effect. He found that the emotional context of the music was very important and the music should be of a calm nature. He also felt that the safety and security of the children was dependent on being able to recognise music, and that one should use music they are used to hearing without too much rhythm and with no surprises in it, i.e. bangs or crashes. Music with too complicated a sound pattern should be avoided. When the rhythm is too strict the therapist cannot be flexible. Music should be of an easy,rhythmic pattern to allow half-speed, ordinary speed or double speed handling techniques.

Lund has been using sinusoidal tones (low frequencies) in harmony with the music. He is using amplitude variation at a rate of three to seven seconds between the peaks. He has found that:

If the peaks are too fast, they will interfere with the music. If the peaks are too far apart, there will be no positive effect. He has been working mostly at the 40 Hz level and has found it has such a weak tonality that it can blend with almost anything. The relevance of the music bed gives at least two dimensions to stimulation hearing and touching. In so far as he is reducing pain, Lund has found that the massive tactile stimulus of the "music bed" going into the brain can reduce or block the pain stimulus.

Bio Feedback.

Lund has been measuring pulse and muscle tone through a simple pulsometer and an EMG monitor. He uses the digital pulse meter and has found that the pulse rate was raised and became erratic at first, but was gradually stabilised over the period of time.

Lund has not been using bio feedback yet and the EMG readouts have shown an initial peaking and then a marked decreasing of the muscle tone.

Bilden has been using a Music Bed since August of 1986. She works half time in a Health Centre, and half time in a new special school for cerebral palsied children. She has had no previous experience of using music in treatment.

First Client.

Thirteen years old, very retarded, spastic in extremities, self stimulating, has reduced hearing and it is frequently difficult to tell whether he is in spasm or involuntary stretching. Bilden was concerned to identify whether Vibro-Acoustic therapy could help to develop functional movements. She used a cassette with changing sinusoidal tones - 40-60-80-60-40 Hz. The client seemed to predominantly enjoy the experience on the music bed, but on one or two occasions he said he did not like it. He has improved a lot over the last year, and particularly has developed more eye contact and awareness. Of particular significance is that Bilden has found it much easier to do movements with the client on the bed because muscle tone has decreased. As with Lund, she is combining the use of the bed with movement and activity. She is intending to continue using Vibro-Acoustic therapy with this client and will more properly be able to evaluate its effect after further treatment.

Second client.

7 year old boy in a wheelchair. Lacks stability (Athetoid). Good at rolling, enjoys movements. They use sign language with him because he is hearing impaired. Audiologist wanted him to experience vibrations because of his auditory problems. They intend to develop physiowork on M.B.

Third client.

6 years old, flexor pattern in upper trunk and body. Extensor spasms in the legs. Both hips in locked flexed position making abduction difficult.

Again Bilden has combined music, Vibro-Acoustic therapy and movement. She also feels it is important to find music that the clients like and that the client can become more spastic when music is used with which they are not familiar.

Specific results from work with this client have been as follows:

1. The beneficial effect is longer than the school day.

2. The client is more physically active than before.

WORK WITH STROKE PATIENTS

Bilden was concerned here to investigate the reduction of spasms and to evaluate how Vibro-Acoustic therapy could facilitate ordinary physiotherapy work with these clients.

She followed the theory that low frequencies reduce spasms and with aphasia patients she has combined Vibro-Acoustic treatment with movement.

Client 1 - 40 year old man paralysed in both legs, hemiplegia due to a spinal lesion. The client was aggressive and impatient when he first came for treatment in the Physiotherapy Department. Vibro-Acoustic therapy has been effective in enabling Bilden to work with him and to break the spasticity when he is on the music bed. Now he has calmed and very rarely becomes aggressive.

Client No. 2 - 40 year old man, fit, total paralysis of right side also aphasia. He had a very stiff right arm and legs, a combination of dysarthria and aphasia and could only nod or whisper.

Bilden used 68 Hz sinusoidal tones. She achieved distal movements in the music bed which the client could not get spontaneously. He was able to stretch his fingers in the music bed which was impossible on the ordinary bench. There was a break for Christmas vacation, and when he returned he was much worse - overgripping with his right arm. She used 40 Hz to try and get the fingers moving again. After only 5 to 10 minutes she was able to stretch his fingers.

Bilden feels it is very beneficial for this patient to be using the music bed. One possible side issue was that after using the music bed he was able to produce sounds, and began to produce them all way through the vocal range.

Rheumatic patients.

Bilden was working with four clients age range 20 to 25 years.

Patient 1 Painful hips and knees. He was unable to go to work, but after some treatment on the music bed he returned to work.

Patient No.2 23 years old. all joints very painful and on considerable medication. The music bed was influential at first, and they were able to decrease medication. They were using the mid range frequency, 68 Hz.

Unfortunately due to problems of attending hospital (being taken to and from the unit) he relapsed.

Patient No. 3 This patient reported he could identify where the pain was coming from after using the music bed, instead of a general experience of pain everywhere. The sound and the music induced relaxation. The music was unknown to the client, and the pain was reduced during treatment every time except one. This client also noticed that headaches he had been experiencing disappeared during the low frequency sound therapy.

His hunger feelings disappeared, and he became more flexible. (Using Romanowsky's music with a 68 Hz sinusoidal tone)

Patient No. 4 This patient experienced pain in the muscles after the first treatment. This was evaluated and they decided they had to make sure the frequencies were affecting the head and neck area (top of the spine) rather than lower down.

Bilden treats her patients for 20 to 30 minutes, and then reduces the sound levels slowly. She then allows them to lie there for two to three minutes at the end of the treatment. She raised queries on how many treatments should be given and for how long. Also in order to evaluate the work, whether to have a period of treatment followed by a gap, followed by a further period of treatment to evaluate the actual effect of the M.B.

Emphysema and Poly-arthritic Patients.

Bilden has also reported on using the music bed on these types of clients. They are chronic patients who have had long-standing treatment. They are using 52 Hz sinus tones as a supplement to physio treatment.

She found that the poly-arthritic patients had relief of pain in the small joints.

With emphysema patients she found that is was easier to excrete sputum - the technique being to give the patient postural drainage first which would bring up as much of the sputum as they can in that position, following which they had a period on the music bed which they found enabled the patient to produce more sputum. These patients felt better for the whole of the rest of the day, which indicates that the relief last longer than with ordinary treatment.

Bilden felt there were lots of positive results from the use of the music bed and they will continue with their programmes using it.

She felt it was particularly useful in remission periods for relief of pain. Bilden has also been using the music bed for cystic fibrosis clients, to good effect.

Mrs. Daniell gave a report on her work with psychotic children and autistic children, and some of her work with adults. She also defined an assessment information chart which she has developed in evaluating the effect of the music bed.

One or two instances she had reported to the Seminar were:

1. A 25 year old male who has fairly lengthy sessions in low frequency sound therapy during which time he will sleep for some period. She reported that he is more attentive after this period.

2. She noted one client she sees who has constipation problems and misses sessions fortnightly for enemas. In this case the client's constipation problems had decreased since the treatment began on the music bed, and enemas were less frequent.

FIFTH PAPER - ARILD HØIE - SYKEPLEIESJEF (Chief Community Nurse)

Kåfjord.

Høie admitted initially he had been sceptical of the use of low frequency sound therapy. It had been effective in helping his wife's back problems so he instituted using it with a variety of clients.

Høie was not so much interested in using music, as opposed to just using the sinusoidal tones (Low frequency sounds). He was particularly concerned on their impact on certain illnesses:

Shoulder pain 68 Hz. He uses treatment for anything between 3 and 4 minutes up to 15 minutes. He lies his clients on the music bed and uses no movements. He believes the clients should move and find the point on the bed which is most comfortable for them to lie on.

Arthritics' patients - pains in the joints, muscle pains of other origins (Mb. Bechterew), tense muscles.

He was dealing with people who had had this ailment for many years, and they are the group who have been using low frequency sound therapy for the longest time. His results are based on the patients' own assessment of their problems. Generally their mobility has improved, the pain has reduced, muscles are softer and they use less analgesics. They have found that the effect of one treatment can last for up to a week.

Høie has achieved good results in this area, particularly with stretched or twisted muscles. He also noted some contraindications:

1. He stopped treatment when he found clients had inflammation

conditions.

2. He also found that using loud volumes with low frequency sound caused

choking sensations with one very small client. Treatment using less

volume was beneficial.

Mr. Wigram and Mrs. Weekes were impressed with the two-day Conference, and the professionalism and diversity in approach of the delegates. They have developed a variety of different approaches in using low frequency sound therapy, and were particularly concerned in evaluating effectively its long-term and short-term results. The delegates were from a variety of different backgrounds and areas of Norway, and included for example, one of the top physiotherapists in the country who heads a physio department in one of the main Oslo-hospitals - specialising in head injuries. She is using the music bed in her location with noticeably good results.

The general conclusion is that this is a powerful and unexplored (outside Norway) treatment method, that can be widely applied to various different problems.

I was impressed by the professional development of the Vibro Acoustic equipment in Norway. I made contact with two physiotherapists who are using the "music bed" with a wide range of patients - Unni Bilden, who treats C.P., respiratory problems, arthritic problems, stroke patients. She finds it easier to treat her patients on a music bed because it reduces spasm and pain.

Sigrun Wetterhus, is one of the leading physiotherapists in Norway. She runs the head injuries unit in Oslo and has twenty years experience in the neurological field. She is finding the "music bed" beneficial for her patients.

I would like patients in the mental handicap unit to benefit from the use of vibro acoustic therapy and to research the physiological effects.

A.L. Wigram - Head III Music Therapist, Harperbury Hospital

L.R. Weekes - Senior I Physiotherapist, Harperbury Hospital

---------------------------------------

Harperbury Hospital

Music Therapy Department Physiotherapy Department

REPORT ON THE EARLY STAGE OF THE VIBRO-ACOUSTIC THERAPY

PROGRAMME.

20th November 1987

Following the construction and siting of low frequency sound therapy equipment in the C.P.U., Harperbury Hospital, Radlett, Hertfordshire, England, a Seminar week was held at the beginning of October, and Professor Olav Skille from Norway visited to conduct workshops. The workshops were received with great interest in the hospital, and from related professionals in other hospitals locally and from further afield, and the concept of use in low frequency sound in the treatment of certain conditions was accepted as a technique that should be pursued with many mentally handicapped clients at Harperbury. The early results of this work have been exiting in their short term effect of this type of therapy. Evaluations are going to be done on some of the clients specified below, and further considerations given to the frequency of sessions for different conditions, and how long lasting the effect is. Some referrals were made by the staff, and these also highlighted some very interesting results, and enabled us to evaluate more carefully the effect as the staff concerned were able to describe their experience both in terms of immediate outcome and the middle to long term effect.

The following clients are being treated:

4. Roland

5. Jess

6. Vera

7. Emily

8. Louisa

9. Robert

10. Mark

11. Angela

12. David

1. SUE

2. JANET

3. ALISON

4. JEAN

5. LYN

6. NANCY

SUMMARY

These results are encouraging, and point the way to a need for more detailed evaluation of the effects of different frequencies and different types of music on specific conditions. The present method of treating involves physical measurement and observed physical responses, and we are concerned in the future to evaluate through autonomic response systems in order to qualify what short and long term effect the treatment is having. We are concerned that it should be possible to specifically identify the level of frequency and style of music that can be "prescribed" for pathological problems. The result will be achieved by some lengthy and detailed research with many different clinical groups.

Tony Wigram Lyn Weekes

Head III Music Therapist Senior I Physiotherapist

.................................................................

Petri Lehikoinen:

(Report to Olav Skille 1988)

The Vibro-acoustic method and equipment were developed and patented in Norway by Olav Skille in the 70's and 80's. The equipment consists of a vibration unit, and audio unit and soft-ware. In this experiment the vibration unit was a bed model. Chair model is also available. As an audio unit we used a set of ear phones.

The soft-ware was produced by Vibro-Soft a/s Inc. This consisted of several types of compositions combined with low sinus tone frequencies varying from 40 Hz to 86 Hz. The effect of pure sinus tone and low frequencies has been known for thousands of years. In several primitive cultures methods and instruments have been developed to treat different psychosomatic disorders or develop an optimum balance between soma and psyche. For example in the singing technique of Tuvas the effect of the sinus tones in human voice was known. In the shamanistic music the physical vibrations were commonly used. In the past five years several projects in Finland and in Norway have been carried out to survey the possibilities of electronic sinus tones and equipment to produce the same effects, which were known in shamanistic tradition. Now we already know that Vibro-acoustic treatment has been effective in the treatment of stress, insomnia, muscle pains and tensions, rheumatic pains, menstrual pains, reduced blood circulation and neck, shoulder and back pains. Medical research on new application and the control of the counter indications is continued.

This experiment was varied out in one of the large insurance companies in Helsinki "Kansa Ltd". We had found that there are certain factors, which increase stress among office workers and that this stress can be reduced by organizing the work in a new and better way and by giving a proper educational support to develop a better professional identity. In this experiment we wanted to compare if Vibro-acoustic treatment would also be an effective method to decrease stress in working life.

The project group consisted of three persons. Raimo Vainio was director of the educational department of the Kansa Group and represented the company. Hannu Naukkarinen as specialized psychiatrist represented the Psychiatric clinic of the Helsinki University. He was responsible for the stress and hormonal tests. Petri Lehikoinen as a clinical psychologist and music therapist was responsible for the practical realization of the Vibro-acoustic treatment and educational applications. All directors, health officers and the trade union people in the company were thoroughly informed about all the details before the start of the project.

32 volunteer office workers were selected for the project so that it was possible to divide them into two comparable groups according to their age and type of work.

Group one was called an educational group. They attended once a week a training session. In these sessions they received information about the psychological factors on the professional identity and tried to improve their skills in human communication and emotional control. The sessions lasted 60 minutes.

Group two was called a relaxation group. They received Vibro-acoustic treatment twice a week for 25 - 30 minutes at a time. Both programs continued for three months ( 15.2. - 15.5. -87 ).

The following methods were used to evaluate the results:

1. The normal physical examination

2. Psychiatric interview

3. Spielberger scale

4. Hamilton index

5. Stresshormone analysis (adrenaline, nor-adrenaline, cortisol)

The test subjects were tested both in the beginning and at the end of the research period. The stress hormone changes were measured only from four test subjects because of the cost of this kind of test. The research group was able to get the test results from 13 (out of 15) test subjects in the educational group and from 15 (out of 17) in the relaxation group.

The hypothesis in this project was as follows:

The results support both the parts of the research hypothesis.

In the educational group the stress level was reduced on the average of 5,54 points. The level of anxiety was reduced 3,38 points, depression by 2,38, Hamilton anxiety 13,346 and panics 6,36 points per a person.

In the relaxation group the same figures were:

Stress level decreased by 5,07, anxiety 2,53, depression increased by 1,47, Hamilton anxiety decreased 6,87 and the panic anxiety decreased 2,93. The decreasing detail in almost all the tests is obvious. The interesting detail in the very slight increase of the depression in the relaxation group. This probably is occasional, but if it appears to be a constant phenomenon it possibly could be interpreted so that Vibro-acoustic treatment as a fairly mechanical relaxation method is not very effective to change the constructive features of life situation.

The results of the stress hormone analysis show that also the endocrinological functions follow the vibration stimulation. The tests were- however - too few to lead to further conclusions. More measurements are needed.

The primary interest was in the psychological factors, but in the interviews of several persons reported also about the somatic results. Two test persons had a chronic headache which disappeared during the research period. Several persons reported about the decrease of back and shoulder pains. All the test subjects in the relaxation group were satisfied with the treatment and hoped to be able to take part in a new project as soon as possible.

The test subjects in the educational group reported, that the training had helped them in the four following areas:

All the participants in the educational group reported their willingness to also receive the Vibro-acoustic treatment.

In this chapter the changes in each test subject during the project are analyzed individually. On the following tables points are given in measured factors to each test subject before and after the project. Estimates were made by Hannu Naukkarinen, Licentiate in Medicine, and they follow the international standards. The measured factors were stress, anxiety, Hamilton-anxiety (psychosomatic), and depression. The increase, decrease and stability of a factor and the range of change were estimated.

According to the results it seems that in both groups a positive progress was made, but consistently the relaxation group achieved better results. If this trend is also shown in further research projects, it would be reasonable to develop the Vibro-acoustic method to utilize it in working life to reduce stress. In this research the results are not absolutely reliable because of the small number of subjects. Anyhow, the results are promising and encouraging for further research.

CHANGES IN STRESS FACTORS OF EACH TEST SUBJECT.

Unchanged 27% 8 %

Increased 20% mean 2,3 46% mean 2,2

Decreased 53% mean 1,9 46% mean 2,0

In decreasing stress factor the difference between relaxation group and educational group is not big, but noticeable ( in relaxation group 53% - in educational group 46% ). But if the number of test subjects reporting unchanged or decreased stress level are added up in both groups and then compared. the difference is remarkable ( in relaxation group 80% - in educational group 54% ).

In the project relaxation and education were found useful. some problems and pressure were caused by the times. sometimes it was impossible for a test subject to withdraw from work, especially the educational group had problems because of the group work and because the program they had was meant to be fixed and systematically advancing. In the relaxation group there was more chances for flexibility because the times were fixed individually. But still all test subjects in this group missed a couple of treatments. In the future we aim at such a system, in which workers could arrange the times by themselves. The equipment should also be near enough so no too much time would be wasted on the way. Besides the bed model there is a chair model which can be placed in any ordinary office. This chair model is also quite soundproof so it could be used without disturbing other workers. Still the Vibro-acoustic treatment should be in medical control to ease research work and because treatment without control might not be regular. It would be a good idea to develop both the Vibro-acoustic method and the education and utilize them together. The results might be considerably better.

Unchanged 33% 15%

Increased 20% mean 3,0 23% mean 2,0

Decreased 47% mean 2,7 62% mean 1,8

The anxiety level decreased in both groups. 62% of test subjects in the educational group felt decrease of anxiety, which is much more than in the relaxation group. But if the test subjects reporting unchanged or decreased levels of anxiety are added up in both groups, the result is 80% in the relaxation group and 77% in the educational group. So education seems to have at lest as much effect as the Vibro-acoustic method.

Unchanged 20% 00%

Increased 13% mean 2,0 38% mean 6,0 (4,0)

Decreased 67% mean 5,4 62% mean 8,3

The difference in decrease is not so clear ( in relaxation group 67% of test subjects while in educational group 62% ). But in the educational group there were quite many reports of increase ( 38% ). The percentage of test subjects reporting unchanged or decreased values were 87% in the relaxation group and 62% in the educational group.

Unchanged 67% 23%

Increased 13% mean 2,5 15% mean 3,0

Decreased 20% mean 5,4 46% mean 2,5

When this table is studied, attention is drawn to many zeroes in the starting values of test subjects in the relaxation group. It could just be a whim of chance, but can also be explained so that the test subjects in relaxation group expected something new and unique and because of that they had a positive attitude. Many in the educational group thought that they were going to take part in conventional in-service training, which is given by the company otherwise and were therefore disappointed. It is worth noticing the decrease of depression factor also in this group.

This experiment was a first attempt to apply the Vibro-acoustic method in working life. It is quite obvious that there are very many uncontrolled factors in this kind of applied research. Working people cannot take part in project carried out in laboratory conditions. In a business organization like the Kansa-Group, this kind of experiment is also unique. The experiences were primarily positive and the company is ready to continue to develop the method for to better fulfil the expectations of the organization. There is also much to do to find the best follow-up systems. The hormone tests are a fairly expensive and complicated method for everyday use, but for collecting data for basic research they are necessary. For everyday use the measuring of pulse, blood pressure and EMG should be sufficient. From the acoustical-physical point of view one maybe important finding was made. When we went through the sinus tone frequencies, which test subjects felt most positive and pleasant, we noticed that they fairly often were related to the overtone series of the Index of Schumann. This is the pulsation of the electromagnetic field of Earth ( 8 Hz ). Some examples of these positive frequencies : 40 Hz = 5 x 8 Hz, 7 x 8 Hz = 56 Hz, 9 x 8 Hz = 72 Hz etc.

An Estonian research team has studied 40 neurotic patients and have come to the conclusion that 10 treatment sessions seem to be the most effective number of treatments. The informations have been processed by computer and are within the required statistical probability levels.

The patients were first consulted by various physicians, - therapist, neurologist and cardiologist, and the patients with diagnosis hypertension were treated by the VA-team. Another group of patients were selected by the psychiatrist from the dept. of neurosis in the Psychiatric Hospital of Tallinn.

N= 25. 72% female, 28% male.Age: 21-60 years.

Professions: Leaders of social and industrial enterprises and employees of the same enterprises.

Complaints: Depression, asthenia, hypochondria, hypertension.

Subjective symptom reports: Cry often, Headache, Tachycardia,

An analysis of the changes in blood pressure shows the progress of BP changes during the 5 weeks of the described project:

BP syst before treatment, Week 1: >130 44,6% diast >80: 56,0%

after treatment , Week 1: >130 32,0% diast >80: 52.0%

BP syst before treatment, Week 5: >130 47,6% diast >80: 38,2%

after treatment, Week 5: >130 38,2% diast >80: 48,8%

The Estonian research team is summing up their findings by describing the results this way:

tired, less headache, less distressed, less trembling of

hands)

improved.

go on in this field.

5. EEG - large individual differences, and it still needs more

research.

The effect of treatment is as follows: Rise of self confidence, less stomach troubles, less head-aches, less depression and asthenia. The patients feel better in the job situation.

The Estonian team say that the VA-methods can play a considerable part in the treatment of neurotic patients and patients with hypertension. Good results have already been achieved.

The preceeding pages were included in the first Manual of VAT which I made in 1991. Much has happened since then. Many VAT-clones have appeared in various parts of the world, and it seems that this method of improving the life-quality of people who suffer from various disorders is widely used.

It is satisfying to notice that my original ideas have proved to be right.

Justifyable critisism has been raised against the methods I have used - Let us say that much of my work was done by intuition. The critisists are welcome to find the elements, in which I was wrong, and I hope they are able to use scientifically acceptable methods. Nothing can bring so much joy to my heart than serious research which can bring more knowledge on VAT.

Until I am proven to be wrong, I keep the privilege to believe that I was right!

Levanger, 10. June 1998.