Chamomile

Botanical Name: Matricaria chamomilla
Family: Asteraceae
Tribe: Anthemideae
Genus: Matricaria
Species: M. chamomilla
Kingdom: Plantae
Order: Asterales

Synonym: Matricaria recutita

Common Names:Chamomile, German chamomile, Hungarian chamomile (kamilla), wild chamomile or scented mayweed,

Habitat:Chamomile is native to southern and eastern Europe. It is also grown in Germany, Hungary, France, Russia, Yugoslavia, and Brazil. It was introduced to India during the Mughal period, now it is grown in Punjab, Uttar Pradesh, Maharashtra, and Jammu and Kashmir. The plants can be found in North Africa, Asia, North and South America, Australia, and New Zealand. Hungary is the main producer of the plant biomass. In Hungary, it also grows abundantly in poor soils and it is a source of income to poor inhabitants of these areas. Flowers are exported to Germany in bulk for distillation of the oil. It often grows near roads, around landfills, and in cultivated fields as a weed, because the seeds require open soil to survive.

Description:
Chamomile is an annual plant with thin spindle-shaped roots only penetrating flatly into the soil. The branched stem is erect, heavily ramified, and grows to a height of 10–80 cm. The long and narrow leaves are bi- to tripinnate. The flower heads are placed separately, they have a diameter of 10–30 mm, and they are pedunculate and heterogamous. The golden yellow tubular florets with 5 teeth are 1.5–2.5 mm long, ending always in a glandulous tube. The flowers bloom in early to midsummer, and have a strong, aromatic smell. The flowers are 6–11 mm long, 3.5 mm wide, and arranged concentrically. The receptacle is 6–8 mm wide, flat in the beginning and conical, cone-shaped later, hollow—the latter being a very important distinctive characteristic of Matricaria—and without paleae. The fruit is a yellowish brown achene.

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Cultivation:
German chamomile can be grown on any type of soil, but growing the crop on rich, heavy, and damp soils should be avoided. It can also withstand cold weather with temperature ranging from 2°C to 20°C. The crop has been grown very successfully on the poor soils (loamy sand) at the farm of the Regional Research Laboratory, Jammu. At Banthra farm of the National Botanical Research Institute, Lucknow, the crop has been grown successfully on soil with a pH of 9. Soils with pH 9–9.2 are reported to support its growth. In Hungary, it grows extensively on clayey lime soils, which are barren lands and considered to be too poor for any other crop. Temperature and light conditions (sunshine hours) have greater effect on essential oils and azulene content, than soil type. Chamomile possesses a high degree of tolerance to soil alkalinity. The plants accumulate fairly large quantity of sodium (66 mg/100 gm of dry material), which helps in reducing the salt concentration in the top soil.[43] No substantial differences were found in the characteristics of the plants grown 1500 km apart (Hungary–Finland). Under cooler conditions in Finland, the quantity of the oxide type in the essential oil was lower than in Hungary.

Propagation:
The plant is propagated by seeds. The seeds of the crop are very minute in size; a thousand seeds weigh 0.088–0.153 gm. About 0.3–0.5 kg of clean seed with a high germination percentage sown in an area of 200–250 m2 gives enough seedlings for stocking a hectare of land. The crop can be grown by two methods i.e. direct sowing of the seed and transplanting. Moisture conditions in the field for direct sowing of seeds must be very good otherwise a patchy and poor germination is obtained. As direct sowing of seeds usually results in poor germination, the transplanting method is generally followed. The mortality of the seedlings is almost negligible in transplanting.

Medicinal Uses:
Chamomile is used in herbal medicine for a sore stomach, irritable bowel syndrome, and as a gentle sleep aid. It is also used as a mild laxative and is anti-inflammatory and bactericidal. It can be taken as an herbal tea, two teaspoons of dried flower per cup of tea, which should be steeped for 10 to 15 minutes while covered to avoid evaporation of the volatile oils. The marc should be pressed because of the formation of a new active principle inside the cells, which can then be released by rupturing the cell walls, though this substance only forms very close to boiling point. For a sore stomach, some recommend taking a cup every morning without food for two to three months. It has been studied as a mouthwash against oral mucositis ]and may have acaricidal properties against certain mites, such as Psoroptes cuniculi.

One of the active ingredients of its essential oil is the terpene bisabolol. Other active ingredients include farnesene, chamazulene, flavonoids (including apigenin, quercetin, patuletin and luteolin) and coumarin.

Dried chamomile has a reputation (among herbalists) for being incorrectly prepared because it is dried at a temperature above the boiling point of the volatile components of the plant.

Chamomile is used topically in skin and mucous membrane inflammations and skin diseases. It can be inhaled for respiratory tract inflammations or irritations; used in baths as irrigation for anogenital inflammation; and used internally for GI spasms and inflammatory diseases. However, clinical trials supporting any use of chamomile are limited.

Possible Side Effects:
Chamomile, a relative of ragweed, can cause allergy symptoms and can cross-react with ragweed pollen in individuals with ragweed allergies. It also contains coumarin, so care should be taken to avoid potential drug interactions, e.g. with blood thinners.

While extremely rare, very large doses of chamomile may cause nausea and vomiting. Even more rarely, rashes may occur. A type-IV allergic reaction with severe anaphylaxis has been reported in a 38-year old man who drank chamomile tea.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any
supplement, it is always advisable to consult with your own health care provider.

Resources:
http://en.wikipedia.org/wiki/Matricaria_chamomilla
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210003/
http://www.drugs.com/npp/chamomile.html

Palmar hyperhidrosis

Description:
Palmer hyperhidrosis is profuse perspiration (excessive sweating) of the palms.It is one form of focal hyperhidrosis, meaning profuse perspiration affecting one area of the body. Sweaty palms may be accompanied by profuse perspiration of the feet, forehead, ckeeks, armpits (axillae) or be part of general hyperhidrosis (profuse perspiration throughout the body). Hyperhidrosis refers to profuse perspiration beyond the body’s thermoregulatory (temperature control) needs.

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Palmer  hyperhidrosis is a common condition in which the eccrine (sweat) glands of the palms and soles secrete inappropriately large quantities of sweat. The condition may become socially and professionally debilitating. The condition usually is idiopathic  and  it begins in childhood and frequently runs in families.

Symptoms:
The intensity of symptoms may vary among sufferers and trigger factors should be carefully noted. Common symptoms  are :

*Perspiration of the hands can vary from mild clamminess to severe perspiration resulting in dripping sweat.
*Temperature differences of palmar surface compared to surface temperature of other parts of the body may be noted.
*Sloughing (peeling) of skin may be noted in profuse perspiration.
*Episodes of profuse perspiration may be followed by periods of extreme dryness on the palmar surface.
*Hyperhidrosis often starts in puberty, and family history is often reported.

The secondary effects of palmar hyperhidrosis can result in both psychosocial effects as well as difficulty in undertaking certain tasks or handling equipment. Sufferers of palmar hyperhidrosis are often reluctant to partake in socially expected actions like shaking hands or touching loved ones. The embarrassment of dealing with this condition can affect the level of interactivity in both social and work situations. Difficulties with holding objects, gripping equipment or soiling electronic devices like keyboards may affect functioning at work. Daily activities such as writing with a pen or counting cash notes is often difficult.

Causes:
Hyperhidrosis is either primary focal or secondary generalized.

1. Primary Palmar  Hyperhidrosis

Focal palmar hyperhidrosis is usually localized and is referred to as primary (essential, idiopathic), meaning no obvious cause, except strong family predisposition can be found (4,5), and affected persons are otherwise healthy . Sweating on other locations as feet, armpits and face may appear. Primary palmar hyperhidrosis is caused by overactivity of the sympathetic nervous system, primarily triggered by emotional causes including anxiety, nervousness, anger and fear .

There may be a significant reduction in perspiration during sleep or sedation.

2. Secondary Palmar Hyperhidrosis

In secondary palmar hyperhidrosis hands sweat due to an obvious underlying disorder like:

*Infections including local infections, tuberculosis and tinea ugunium.
*Neurological disorders like peripheral autonomic neuropathy
*Frostbite
*Arteriovenous Fistulas
*Acromegaly
*Acrodynia
*Complex Regional Pain Syndromes
*Pachyonychia Congenita
*Primary Hypertrophic osteoarthropathy
*Dyskeratosis Congenita
*Blue rubber-bleb nevus
*Glomus tumor

*Secondary palmar hyperhidrosis as part of generalized hyperhidrosis due to  several  hormonal causes (diabetes, hyperthyroidism, thyrotoxicosis, menstruation, menopause), metabolic disorders, malignant disease (lymphoma, pheochromocitoma), autoimmune disorders (rheumatoid arthritis, systemic lupus erythrematosus), drugs like hypertensive drugs and certain classes of antidepressants (list of medications causing hyperhidrosis), chronic use of alcohol, Parkinson’s disease, neurological disorders (toxic neuropathy), homocystinuria, plasma cell disorders. Detailed list of conditions causing generalyzed hyperhidrosis.

How Sweat Glands Work:
In eccrine glands, the major substance enabling impulse conduction is acetylcholine, and in apocrine glands, they are catecholamines.

Body temperature is controlled by the thermoregulatory center in the hypothalamus and this is influenced not only by  by core body temperature but also by hormones, pyrogens, exercise and emotions.

Diagnosis:
The first step in diagnosing  the  Palmar  hyperhidrosis is to differentiate between generalized and focal hyperhidrosis.

A thorough case taking and medical history is usually sufficient to diagnose palmar hyperhidrosis and any trigger factors (scheduled drugs, narcotics, chronic alcoholism).

Diagnostic criteria for primary focal (including palmar) hyperhidrosis  are:

*Bilateral and relatively symmetric sweating
*Frequency of at least 1 episode per week
*Impairment of daily activities
*Age at onset before 25 years
*Family history
*Cessation of sweating during sleep

Tests may include:
*Hematological studies may be necessary to identify thyroid disorders (thyroid function test for T3 and T4 as well as thyroid antibodies) and diabetes (fasting blood glucose or a glucose tolerance test).

*X-rays and MRI scans will assist for diagnosing tuberculosis, pneumonia and tumors.

*Superficial electroconductivity can be monitored as any hyperhidrosis reduces skin electrical resistance.

*Thermoregulatory sweat test uses moisture-sensitive indicator powder to monitor moisture. Changes in the color of the powder at room temperature will highlight areas of increased perspiration.

Treatment:
Conservative management should be coupled with prescribed treatment by the Doctor to reduce the symptoms.

*Counseling may be effective in managing primary palmar hyperhidrosis in cases of mental-emotional etiology.

*Trigger foods and aggravating factors should be noted if possible and relevant dietary changes should be implemented.

*Effective prevention of secondary palmar hyperhidrosis is difficult with conservative management and drug therapy or surgery may be required.

*Excessive physical activity and extremes of heat may be two trigger factors that should be avoided as far as possible.

*In cases of diabetes, a glucose controlled diet with low glycemic index may improve glucose tolerance which could assist with palmar hyperhidrosis.

*Abstinence from alcohol and narcotics is advisable if it is the causative factor for sweaty palms.

*Stimulants such as caffeine and nicotine may aggravate palmar hypehidrosis and should relevant dietary and lifestyle changes should be implemented.

*Anti-perspirant compounds like aluminum chloride can be applied on the palms to reduce moisture or palmar surfaces. Recent research on an aluminum sesquichlorohydrate foam has shown that it is effective in reducing sweat in palmar hyperhidrosis

Treatment remains a challenge: options include topical and systemic agents, iontophoresis, and botulinum toxin type A injections, with surgical sympathectomy as a last resort. None of the treatments is without limitations or associated complications. Topical aluminum chloride hexahydrate therapy and iontophoresis are simple, safe, and inexpensive therapies; however, continuous application is required because results are often short-lived, and they may be insufficient. Systemic agents such as anticholinergic drugs are tolerated poorly at the dosages required for efficacy and usually are not an option because of their associated toxicity. While botulinum toxin can be used in treatment-resistant cases, numerous painful injections are required, and effects are limited to a few months.

Standard therapeutic protocol may differ among cases of palmar hyperhidrosis depending on medical history and underlying pathology.

*Anticholinergic drugs have a direct effect on the sympathetic nervous system although there are numerous side effects.

*Treatment should be directed at contributing factors.

*Ionophoresis involves the use of electrotherapeutic measures to reduce the activity of sweat glands.

*Botulinum injections at the affected area may be useful for its anticholinergic effects.

*Surgery should be considered if drug therapy proves ineffective. Endoscopic transthoracic sympathectomy involves resection of the sympathetic nerve supply to the affected area. This prevents nerve stimulation of the sweat gland of the palms. However surgery has a host of complications including exacerbating the problem or increasing generalized hyperhidrosis.

Surgical sympathectomy should be reserved for the most severe cases and should be performed only after all other treatments have failed. Although the safety and reliability of treatments for palmoplantar hyperhidrosis have improved dramatically, side effects and compensatory sweating are still common, potentially severe problems.

Ayurvedic Treatment ..click & see…>…….…(1) :....(2)

Home Remedies. click & see….>…....(1) :…(2) :.…...(3) :..

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.aafp.org/afp/2004/0301/p1117.html
http://www.healthhype.com/causes-treatment-of-palmar-hyperhidrosis-sweaty-palmshands.html

Immunisation

Definition:
Immunization, or immunisation, is the process by which an individual’s immune system becomes fortified against an agent (known as the immunogen).It  is the process whereby a person is made immune or resistant to an infectious disease.

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Immunization is done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body’s immune system, thus helping to fight or prevent an infection. The fact that mutations can cause cancer cells to produce proteins or other molecules that are known to the body forms the theoretical basis for therapeutic cancer vaccines. Other molecules can be used for immunization as well, for example in experimental vaccines against nicotine (NicVAX) or the hormone ghrelin in experiments to create an obesity vaccine.

Before the introduction of vaccines, the only way people became immune to an infectious disease was by actually getting the disease and surviving it. Smallpox (variola) was prevented in this way by inoculation, which produced a milder effect than the natural disease. It was introduced into England from Turkey by Lady Mary Wortley Montagu in 1721 and used by Zabdiel Boylston in Boston the same year. In 1798 Edward Jenner introduced inoculation with cowpox (smallpox vaccine), a much safer procedure. This procedure, referred to as vaccination, gradually replaced smallpox inoculation, now called variolation to distinguish it from vaccination. Until the 1880s vaccine/vaccination referred only to smallpox, but Louis Pasteur developed immunisation methods for chicken cholera and anthrax in animals and for human rabies, and suggested that the terms vaccine/vaccination should be extended to cover the new procedures. This can cause confusion if care is not taken to specify which vaccine is used e.g. measles vaccine or influenza vaccine.

When this system is exposed to molecules that are foreign to the body, called non-self, it will orchestrate an immune response, and it will also develop the ability to quickly respond to a subsequent encounter because of immunological memory. This is a function of the adaptive immune system. Therefore, by exposing an animal to an immunogen in a controlled way, its body can learn to protect itself: this is called active immunization.

The most important elements of the immune system that are improved by immunization are the T cells, B cells, and the antibodies B cells produce. Memory B cells and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is direct introduction of these elements into the body, instead of production of these elements by the body itself.

The most important elements of the immune system that are improved by immunization are the T cells, B cells, and the antibodies B cells produce. Memory B cells and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is direct introduction of these elements into the body, instead of production of these elements by the body itself.

Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.

Immunizations are definitely less risky and an easier way to become immune to a particular disease than risking a milder form of the disease itself. They are important for both adults and children in that they can protect us from the many diseases out there. Through the use of immunizations, some infections and diseases have almost completely been eradicated throughout the United States and the World. One example is polio. Thanks to dedicated health care professionals and the parents of children who vaccinated on schedule, polio has been eliminated in the U.S. since 1979. Polio is still found in other parts of the world so certain people could still be at risk of getting it. This includes those people who have never had the vaccine, those who didn’t receive all doses of the vaccine, or those traveling to areas of the world where polio is still prevalent.

The Immunization can be achieved in an active or passive manner:
Vaccination is an active form of immunization.

Active immunization/vaccination has been named one of the “Ten Great Public Health Achievements in the 20th Century”.

Active immunization:.click & see
Active immunization can occur naturally when a person comes in contact with, for example, a microbe. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune.

Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated.

The importance of immunization is so great that the American Centers for Disease Control and Prevention has named it one of the “Ten Great Public Health Achievements in the 20th Century”.  Live attenuated vaccines have decreased pathogenicity. Their effectiveness depends on the immune systems ability to replicate and elicits a response similar to natural infection. It is usually effective with a single dose. Examples of live, attenuated vaccines include measles, mumps, rubella, MMR, yellow fever, varicella, rotavirus, and influenza (LAIV).

Passive immunization:……...click & see
Passive immunization is where pre-synthesized elements of the immune system are transferred to a person so that the body does not need to produce these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear.

Passive immunization occurs physiologically, when antibodies are transferred from mother to fetus during pregnancy, to protect the fetus before and shortly after birth.

Artificial passive immunization is normally administered by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment for toxicity, as in for tetanus. The antibodies can be produced in animals, called “serum therapy,” although there is a high chance of anaphylactic shock because of immunity against animal serum itself. Thus, humanized antibodies produced in vitro by cell culture are used instead if available.

Resources:
http://en.wikipedia.org/wiki/Immunization
http://www.who.int/topics/immunization/en/

Complications In Pregnancy

Pre-eclampsia, eclampsia or toxemia of pregnancy
Definition:
Pre-eclampsia or preeclampsia (PE) is a disorder of pregnancy characterized by high blood pressure and a large amount of protein in the urine. The disorder usually occurs in the third trimester of pregnancy and gets worse over time. In severe disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. PE increases the risk of poor outcomes for both the mother and the baby. If left untreated, it may result in seizures at which point it is known as eclampsia.

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Toxemia of pregnancy is a severe condition that sometimes occurs in the latter weeks of pregnancy. It is characterized by high blood pressure; swelling of the hands, feet, and face; and an excessive amount of protein in the urine. If the condition is allowed to worsen, the mother may experience convulsions and coma, and the baby may be stillborn.
The term toxemia is actually a misnomer from the days when it was thought that the condition was caused by toxic (poisonous) substances in the blood. The illness is more accurately called preeclampsia before the convulsive stage and eclampsia afterward.

Preeclampsia affects between 2–8% of pregnancies worldwide. Hypertensive disorders of pregnancy are one of the most common causes of death due to pregnancy. They resulted in 29,000 deaths in 2013 – down from 37,000 deaths in 1990. Preeclampsia usually occurs after 32 weeks; however, if it occurs earlier it is associated with worse outcomes. Women who have had PE are at increased risk of heart disease later in life. The word eclampsia is from the Greek term for lightning. The first known description of the condition was by Hippocrates in the 5th century BCE

Symptoms:
Swelling (especially in the hands and face) was originally considered an important sign for a diagnosis of preeclampsia. However, because swelling is a common occurrence in pregnancy, its utility as a distinguishing factor in preeclampsia is not great. Pitting edema (unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a health care provider.

In general, none of the signs of preeclampsia are specific, and even convulsions in pregnancy are more likely to have causes other than eclampsia in modern practice. Further, a symptom such as epigastric pain may be misinterpreted as heartburn. Diagnosis, therefore, depends on finding a coincidence of several preeclamptic features, the final proof being their regression after delivery.

The symptoms of toxemia of pregnancy (which may lead to death if not treated) are divided into three stages, each progressively more serious:
Mild preeclampsia symptoms include edema (puffiness under the skin due to fluid accumulation in the body tissues, often noted around the ankles), mild elevation of blood pressure, and the presence of small amounts of protein in the urine.

Severe preeclampsia symptoms include extreme edema, extreme elevation of blood pressure, the presence of large amounts of protein in the urine, headache, dizziness, double vision, nausea, vomiting, and severe pain in the right upper portion of the abdomen.
Eclampsia symptoms include convulsions and coma.

Risk Factors:
Known risk factors for preeclampsia include:

*Nulliparity (never given birth)
*Older age, and diabetes mellitus
*Kidney disease
*Chronic hypertension
*Prior history of preeclampsia
*Family history of preeclampsia
*Advanced maternal age (>35 years)
*Obesity
*Antiphospholipid antibody syndrome
*Multiple gestation
*Having donated a kidney.
*Having sub-clinical hypothyroidism or thyroid antibodies

It is also more frequent in a women’s first pregnancy and if she is carrying twins. The underlying mechanism involves abnormal formation of blood vessels in the placenta amongst other factors. Most cases are diagnosed before delivery. Rarely, preeclampsia may begin in the period after delivery. While historically both high blood pressure and protein in the urine were required to make the diagnosis, some definitions also include those with hypertension and any associated organ dysfunction. Blood pressure is defined as high when it is greater than 140 mmHg systolic or 90 mmHg diastolic at two separate times, more than four hours apart in a women after twenty weeks of pregnancy. PE is routinely screened for during prenatal care.
Causes:
There is no definitive known cause of preeclampsia, though it is likely related to a number of factors. Some of these factors include:

*Abnormal placentation (formation and development of the placenta)
*Immunologic factors
*Prior or existing maternal pathology – preeclampsia is seen more at a higher incidence in individuals with preexisting hypertension, obesity, antiphospholipid antibody syndrome, and those with history of preeclampsia
*Dietary factors, e.g. calcium supplementation in areas where dietary calcium intake is low has been shown to reduce the risk of preeclampsia.
*Environmental factors, e.g. air pollution
*Those with long term high blood pressure have a risk 7 to 8 times higher than those without.

Physiologically, research has linked preeclampsia to the following physiologic changes: alterations in the interaction between the maternal immune response and the placenta, placental injury, endothelial cell injury, altered vascular reactivity, oxidative stress, imbalance among vasoactive substances, decreased intravascular volume, and disseminated intravascular coagulation.

While the exact cause of preeclampsia remains unclear, there is strong evidence that a major cause predisposing a susceptible woman to preeclampsia is an abnormally implanted placenta. This abnormally implanted placenta is thought to result in poor uterine and placental perfusion, yielding a state of hypoxia and increased oxidative stress and the release of anti-angiogenic proteins into the maternal plasma along with inflammatory mediators. A major consequence of this sequence of events is generalized endothelial dysfunction. The abnormal implantation is thought to stem from the maternal immune system’s response to the placenta and refers to evidence suggesting a lack of established immunological tolerance in pregnancy. Endothelial dysfunction results in hypertension and many of the other symptoms and complications associated with preclampsia.

One theory proposes that certain dietary deficiencies may be the cause of some cases. Also, there is the possibility that some forms of preeclampsia and eclampsia are the result of deficiency of blood flow in the uterus.

Diagnosis:
Pre-eclampsia is diagnosed when a pregnant woman develops:

*Blood pressure >_ 140 mm Hg systolic or  >_  90 mm Hg diastolic on two separate readings taken at least four to six hours apart after 20 weeks gestation in an individual with previously normal blood pressure.
*In a woman with essential hypertension beginning before 20 weeks gestational age, the diagnostic criteria are: an increase in systolic blood pressure (SBP) of   >_ 30mmHg or an increase in diastolic blood pressure (DBP) of   >_15mmHg.
*Proteinuria  >_ 0.3 grams (300 mg) or more of protein in a 24-hour urine sample or a SPOT urinary protein to creatinine ratio  >_ 0.3 or a urine dipstick reading of 1+ or greater (dipstick reading should only be used if other quantitative methods are not available)

Suspicion for preeclampsia should be maintained in any pregnancy complicated by elevated blood pressure, even in the absence of proteinuria. Ten percent of individuals with other signs and symptoms of preeclampsia and 20% of individuals diagnosed with eclampsia show no evidence of proteinuria. In the absence of proteinuria, the presence of new-onset hypertension (elevated blood pressure) and the new onset of one or more of the following is suggestive of the diagnosis of preeclampsia:

*Evidence of kidney dysfunction (oliguria, elevated creatinine levels)
*Impaired liver function (impaired liver function tests)
*Thrombocytopenia (platelet count <100,000/microliter)
*Pulmonary edema
*Ankle edema pitting type
*Cerebral or visual disturbances
*Preeclampsia is a progressive disorder and these signs of organ dysfunction are indicative of severe preeclampsia. A systolic blood pressure ?160 or diastolic blood pressure ?110 and/or proteinuria >5g in a 24-hour period is also indicative of severe preeclampsia. Clinically, individuals with severe preeclampsia may also present epigastric/right upper quadrant abdominal pain, headaches, and vomiting. Severe preeclampsia is a significant risk factor for intrauterine fetal death.

Of note, a rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is still considered important to note, but is not considered diagnostic.

Predictive tests:
There have been many assessments of tests aimed at predicting preeclampsia, though no single biomarker is likely to be sufficiently predictive of the disorder. Predictive tests that have been assessed include those related to placental perfusion, vascular resistance, kidney dysfunction, endothelial dysfunction, and oxidative stress. Examples of notable tests include:

*Doppler ultrasonography of the uterine arteries to investigate for signs of inadequate placental perfusion. This test has a high negative predictive value among those individuals with a history of prior preeclampsia.
*Elevations in serum uric acid (hyperuricemia) is used by some to “define” preeclampsia,[14] though it has been found to be a poor predictor of the disorder. Elevated levels in the blood (hyperuricemia) are likely due to reduced uric acid clearance secondary to impaired kidney function.
*Angiogenic proteins such as vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) and anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1) have shown promise for potential clinical use in diagnosing preeclampsia, though evidence is sufficient to recommend a clinical use for these markers.
*Recent studies have shown that looking for podocytes, specialized cells of the kidney, in the urine has the potential to aid in the prediction of preeclampsia. Studies have demonstrated that finding podocytes in the urine may serve as an early marker of and diagnostic test for preeclampsia. Research is ongoing.

Differential diagnosis:
Pre-eclampsia can mimic and be confused with many other diseases, including chronic hypertension, chronic renal disease, primary seizure disorders, gallbladder and pancreatic disease, immune or thrombotic thrombocytopenic purpura, antiphospholipid syndrome and hemolytic-uremic syndrome. It must be considered a possibility in any pregnant woman beyond 20 weeks of gestation. It is particularly difficult to diagnose when preexisting disease such as hypertension is present. Women with acute fatty liver of pregnancy may also present with elevated blood pressure and protein in the urine, but differs by the extent of liver damage. Other disorders that can cause high blood pressure include thyrotoxicosis, pheochromocytoma, and drug misuse
Treatment:
Preeclampsia and eclampsia cannot be completely cured until the pregnancy is over. Until that time, treatment includes the control of high blood pressure and the intravenous administration of drugs to prevent convulsions. Drugs may also be given to stimulate the production of urine. In some severe cases, early delivery of the baby is needed to ensure the survival of the mother.

Prevention:
Recommendations for prevention include: aspirin in those at high risk, calcium supplementation in areas with low intake, and treatment of prior hypertension with medications. In those with PE delivery of the fetus and placenta is an effective treatment. When delivery becomes recommended depends on how severe the PE and how far along in pregnancy a person is. Blood pressure medication, such as labetalol and methyldopa, may be used to improve the mother’s condition before delivery. Magnesium sulfate may be used to prevent eclampsia in those with severe disease. Bedrest and salt intake have not been found to be useful for either treatment or prevention.

Diet:
Protein or calorie supplementation have no effect on preeclampsia rates, and dietary protein restriction does not appear to increase preeclampsia rates. Further, there is no evidence that changing salt intake has an effect.

Supplementation with antioxidants such as vitamin C and E has no effect on preeclampsia incidence, nor does supplementation with vitamin D. Therefore, supplementation with vitamins C, E, and D is not recommended for reducing the risk of pre-eclampsia.

Calcium supplementation of at least 1 gram per day is recommended during pregnancy as it prevents preeclampsia where dietary calcium intake is low, especially for those at high risk. Low selenium status is associated with higher incidence of preeclampsia.

Aspirin:
Taking aspirin is associated with a 1% to 5% reduction in preeclampsia and a 1% to 5% reduction in premature births in women at high risk. The WHO recommends low-dose aspirin for the prevention of preeclampsia in women at high risk and recommend it be started before 20 weeks of pregnancy. The United States Preventive Services Task Force recommends a low-dose regimen for women at high risk beginning in the 12th week.

Physical activity:
There is insufficient evidence to recommend either exercise or strict bedrest as preventative measures of pre-eclampsia.

Smoking cessation:
In low-risk pregnancies the association between cigarette smoking and a reduced risk of preeclampsia has been consistent and reproducible across epidemiologic studies. High-risk pregnancies (those with pregestational diabetes, chronic hypertension, history of preeclampsia in a previous pregnancy, or multifetal gestation) showed no significant protective effect. The reason for this discrepancy is not definitively known; research supports speculation that the underlying pathology increases the risk of preeclampsia to such a degree that any measurable reduction of risk due to smoking is masked. However, the damaging effects of smoking on overall health and pregnancy outcomes outweighs the benefits in decreasing the incidence of preeclampsia. It is recommended that smoking be stopped prior to, during and after pregnancy

Restriction of salt in the diet may help reduce swelling, it does not prevent the onset of high blood pressure or the appearance of protein in the urine. During prenatal visits, the doctor routinely checks the woman’s weight, blood pressure, and urine. If toxemia is detected early, complications may be reduced.

Resources:
http://health.howstuffworks.com/pregnancy-and-parenting/pregnancy/complications/a-guide-to-pregnancy-complications-ga13.htm
http://en.wikipedia.org/wiki/Pre-eclampsia

Spina bifida

Definition:
Spina bifida is a type of birth defect called a neural tube defect. It occurs when the bones of the spine (vertebrae) don’t form properly around part of the baby’s spinal cord. Spina bifida can be mild or severe….CLICK & SEE

Spina bifida malformations fall into three categories: spina bifida occulta, spina bifida cystica with meningocele, and spina bifida cystica with myelomeningocele. The most common location of the malformations is the lumbar and sacral areas. Myelomeningocele is the most significant and common form, and this leads to disability in most affected individuals. The terms spina bifida and myelomeningocele are usually used interchangeably.

Spina bifida meningocele and myelomeningocele are among the most common birth defects, with a worldwide incidence of about 1 in every 1000 births. The occulta form is much more common, but only rarely causes neurological symptoms.

Clasification:....CLICK & SEE
Spina bifida occulta:
Occulta is Latin for “hidden”. This is the mildest form of spina bifida. In occulta, the outer part of some of the vertebrae is not completely closed. The splits in the vertebrae are so small that the spinal cord does not protrude. The skin at the site of the lesion may be normal, or it may have some hair growing from it; there may be a dimple in the skin, or a birthmark.

Many people with this type of spina bifida do not even know they have it, as the condition is asymptomatic in most cases. The incidence of spina bifida occulta is approximately 10-20% of the population, and most people are diagnosed incidentally from spinal X-rays. A systematic review of radiographic research studies found no relationship between spina bifida occulta and back pain. More recent studies not included in the review support the negative findings.

However, other studies suggest spina bifida occulta is not always harmless. One study found that among patients with back pain, severity is worse if spina bifida occulta is present.

Incomplete posterior fusion is not a true spina bifida, and is very rarely of neurological significance.

Meningocele:
A posterior meningocele  or meningeal cyst  is the least common form of spina bifida. In this form, the vertebrae develop normally, but the meninges are forced into the gaps between the vertebrae. As the nervous system remains undamaged, individuals with meningocele are unlikely to suffer long-term health problems, although cases of tethered cord have been reported. Causes of meningocele include teratoma and other tumors of the sacrococcyx and of the presacral space, and Currarino syndrome.

A meningocele may also form through dehiscences in the base of the skull. These may be classified by their localisation to occipital, frontoethmoidal, or nasal. Endonasal meningoceles lie at the roof of the nasal cavity and may be mistaken for a nasal polyp. They are treated surgically. Encephalomeningoceles are classified in the same way and also contain brain tissue.

Myelomeningocele:
This type of spina bifida often results in the most severe complications. In individuals with myelomeningocele, the unfused portion of the spinal column allows the spinal cord to protrude through an opening. The meningeal membranes that cover the spinal cord form a sac enclosing the spinal elements. The term Meningomyelocele is also used interchangeably.

Myeloschisis:
Spina bifida with myeloschisis is the most severe form of myelomeningocele. In this type, the involved area is represented by a flattened, plate-like mass of nervous tissue with no overlying membrane. The exposure of these nerves and tissues make the baby more prone to life-threatening infections such as meningitis.

The protruding portion of the spinal cord and the nerves that originate at that level of the cord are damaged or not properly developed. As a result, there is usually some degree of paralysis and loss of sensation below the level of the spinal cord defect. Thus, the more cranial the level of the defect, the more severe the associated nerve dysfunction and resultant paralysis may be. People may have ambulatory problems, loss of sensation, deformities of the hips, knees or feet, and loss of muscle tone.

Signs and symptoms:
Physical complications:

*Leg weakness and paralysis
*Orthopedic abnormalities (i.e., club foot, hip dislocation, scoliosis)
*Bladder and bowel control problems, including incontinence, urinary tract infections, and poor renal function
*Pressure sores and skin irritations
*Abnormal eye movement

68% of children with spina bifida have an allergy to latex, ranging from mild to life-threatening. The common use of latex in medical facilities makes this a particularly serious concern. The most common approach to avoid developing an allergy is to avoid contact with latex-containing products such as examination gloves and condoms and catheters that do not specify they are latex free, and many other products, such as some commonly used by dentists.

The spinal cord lesion or the scarring due to surgery may result in a tethered spinal cord. In some individuals, this causes significant traction and stress on the spinal cord and can lead to a worsening of associated paralysis, scoliosis, back pain, and worsening bowel and/or bladder function

Neurological complications:
Many individuals with spina bifida have an associated abnormality of the cerebellum, called the Arnold Chiari II malformation. In affected individuals, the back portion of the brain is displaced from the back of the skull down into the upper neck. In about 90% of the people with myelomeningocele, hydrocephalus also occurs because the displaced cerebellum interferes with the normal flow of cerebrospinal fluid, causing an excess of the fluid to accumulate.  In fact, the cerebellum also tends to be smaller in individuals with spina bifida, especially for those with higher lesion levels.

The corpus callosum is abnormally developed in 70-90% of individuals with spina bifida myelomeningocele; this impacts the communication processes between the left and right brain hemispheres. Further, white matter tracts connecting posterior brain regions with anterior regions appear less organized. White matter tracts between frontal regions have also been found to be impaired.

Cortex abnormalities may also be present. For example, frontal regions of the brain tend to be thicker than expected, while posterior and parietal regions are thinner. Thinner sections of the brain are also associated with increased cortical folding. Neurons within the cortex may also be displaced.

Executive function:
Several studies have demonstrated difficulties with executive functions in youth with spina bifida, with greater deficits observed in youth with shunted hydrocephalus. Unlike typically developing children, youths with spina bifida do not tend to improve in their executive functioning as they grow older. Specific areas of difficulty in some individuals include planning, organizing, initiating, and working memory. Problem-solving, abstraction, and visual planning may also be impaired.  Further, children with spina bifida may have poor cognitive flexibility. Although executive functions are often attributed to the frontal lobes of the brain, individuals with spina bifida have intact frontal lobes; therefore, other areas of the brain may be implicated.

Individuals with spina bifida, especially those with shunted hydrocephalus, often have attention problems. Children with spina bifida and shunted hydrocephalus have higher rates of ADHD than typically developing children (31% vs. 17%). Deficits have been observed for selective attention and focused attention, although poor motor speed may contribute to poor scores on tests of attention.  Attention deficits may be evident at a very early age, as infants with spina bifida lag behind their peers in orienting to faces.

Academic skills:
Individuals with spina bifida may struggle academically, especially in the subjects of mathematics and reading. In one study, 60% of children with spina bifida were diagnosed with a learning disability.  In addition to brain abnormalities directly related to various academic skills, achievement is likely affected by impaired attentional control and executive functioning. Children with spina bifida may perform well in elementary school, but begin to struggle as academic demands increase.

Children with spina bifida are more likely than their typically developing peers to have dyscalculia. Individuals with spina bifida have demonstrated stable difficulties with arithmetic accuracy and speed, mathematical problem-solving, and general use and understanding of numbers in everyday life. Mathematics difficulties may be directly related to the thinning of the parietal lobes (regions implicated in mathematical functioning) and indirectly associated with deformities of the cerebellum and midbrain that affect other functions involved in mathematical skills. Further, higher numbers of shunt revisions are associated with poorer mathematics abilities. Working memory and inhibitory control deficiencies have been implicated for math difficulties, although visual-spatial difficulties are not likely involved. Early intervention to address mathematics difficulties and associated executive functions is crucial.

Individuals with spina bifida tend to have better reading skills than mathematics skills. Children and adults with spina bifida have stronger abilities in reading accuracy than in reading comprehension. Comprehension may be especially impaired for text that requires an abstract synthesis of information rather than a more literal understanding. Individuals with spina bifida may have difficulty with writing due to deficits in fine motor control and working memory.

Causes:
The exact cause of this birth defect isn’t known. Experts think that genes and the environment are part of the cause. For example, women who have had one child with spina bifida are more likely to have another child with the disease. Women who are obese or who have diabetes are also more likely to have a child with spina bifida.

Spina bifida is sometimes caused by the failure of the neural tube to close during the first month of embryonic development (often before the mother knows she is pregnant). Some forms are known to occur with primary conditions that cause raised central nervous system pressure, which raises the possibility of a dual pathogenesis.

In normal circumstances, the closure of the neural tube occurs around the 23rd (rostral closure) and 27th (caudal closure) day after fertilization. However, if something interferes and the tube fails to close properly, a neural tube defect will occur. Medications such as some anticonvulsants, diabetes, having a relative with spina bifida, obesity, and an increased body temperature from fever or external sources such as hot tubs and electric blankets may increase the chances of delivery of a baby with a spina bifida.

Extensive evidence from mouse strains with spina bifida indicates that there is sometimes a genetic basis for the condition. Human spina bifida, like other human diseases, such as cancer, hypertension and atherosclerosis (coronary artery disease), likely results from the interaction of multiple genes and environmental factors.

Research has shown the lack of folic acid (folate) is a contributing factor in the pathogenesis of neural tube defects, including spina bifida. Supplementation of the mother’s diet with folate can reduce the incidence of neural tube defects by about 70%, and can also decrease the severity of these defects when they occur. It is unknown how or why folic acid has this effect.

Spina bifida does not follow direct patterns of heredity like muscular dystrophy or haemophilia. Studies show a woman having had one child with a neural tube defect such as spina bifida has about a 3% risk of having another affected child. This risk can be reduced with folic acid supplementation before pregnancy. For the general population, low-dose folic acid supplements are advised (0.4 mg/day)

Treatment:
There is no known cure for nerve damage caused by spina bifida. To prevent further damage of the nervous tissue and to prevent infection, pediatric neurosurgeons operate to close the opening on the back. The spinal cord and its nerve roots are put back inside the spine and covered with meninges. In addition, a shunt may be surgically installed to provide a continuous drain for the excess cerebrospinal fluid produced in the brain, as happens with hydrocephalus. Shunts most commonly drain into the abdomen or chest wall. However, if spina bifida is detected during pregnancy, then open or minimally-invasive fetal surgery can be performed.

In childhood:
Most individuals with myelomeningocele will need periodic evaluations by a variety of specialists:

*Physiatrists coordinate the rehabilitation efforts of different therapists and prescribe specific therapies, adaptive equipment, or medications to encourage as high of a functional performance within the community as possible.

*Orthopedists monitor growth and development of bones, muscles, and joints.

*Neurosurgeons perform surgeries at birth and manage complications associated with tethered cord and hydrocephalus.

*Neurologists treat and evaluate nervous system issues, such as seizure disorders.

*Urologists to address kidney, bladder, and bowel dysfunction – many will need to manage their urinary systems with a program of catheterization. Bowel management programs aimed at improving elimination are also designed.

*Ophthalmologists evaluate and treat complications of the eyes.

*Orthotists design and customize various types of assistive technology, including braces, crutches, walkers, and wheelchairs to aid in mobility. As a general rule, the higher the level of the spina bifida defect, the more severe the paralysis, but paralysis does not always occur. Thus, those with low levels may need only short leg braces, whereas those with higher levels do best with a wheelchair, and some may be able to walk unaided.

*Physical therapists, occupational therapists, psychologists, and speech/language pathologists aid in rehabilitative therapies and increase independent living skills.

Transition to adulthood:
Although many children’s hospitals feature integrated multidisciplinary teams to coordinate healthcare of youth with spina bifida, the transition to adult healthcare can be difficult because the above healthcare professionals operate independently of each other, requiring separate appointments and communicate among each other much less frequently. Healthcare professionals working with adults may also be less knowledgeable about spina bifida because it is considered a childhood chronic health condition.  Due to the potential difficulties of the transition, adolescents with spina bifida and their families are encouraged to begin to prepare for the transition around ages 14–16, although this may vary depending on the adolescent’s cognitive and physical abilities and available family support. The transition itself should be gradual and flexible. The adolescent’s multidisciplinary treatment team may aid in the process by preparing comprehensive, up-to-date documents detailing the adolescent’s medical care, including information about medications, surgery, therapies, and recommendations. A transition plan and aid in identifying adult healthcare professionals are also helpful to include in the transition process.

Further complicating the transition process is the tendency for youths with spina bifida to be delayed in the development of autonomy, with boys particularly at risk for slower development of independence. An increased dependence on others (in particular family members) may interfere with the adolescent’s self-management of health-related tasks, such as catheterization, bowel management, and taking medications.  As part of the transition process, it is beneficial to begin discussions at an early age about educational and vocational goals, independent living, and community involvement.

Prevention:
There is neither a single cause of spina bifida nor any known way to prevent it entirely. However, dietary supplementation with folic acid has been shown to be helpful in reducing the incidence of spina bifida. Sources of folic acid include whole grains, fortified breakfast cereals, dried beans, leaf vegetables and fruits.

Folate fortification of enriched grain products has been mandatory in the United States since 1998. The U.S. Food and Drug Administration, Public Health Agency of Canada  and UK recommended amount of folic acid for women of childbearing age and women planning to become pregnant is at least 0.4 mg/day of folic acid from at least three months before conception, and continued for the first 12 weeks of pregnancy.  Women who have already had a baby with spina bifida or other type of neural tube defect, or are taking anticonvulsant medication should take a higher dose of 4–5 mg/day.

Certain mutations in the gene VANGL1 are implicated as a risk factor for spina bifida: These mutations have been linked with spina bifida in some families with a history of spina bifida.

Pregnancy screening:
Open spina bifida can usually be detected during pregnancy by fetal ultrasound. Increased levels of maternal serum alpha-fetoprotein (MSAFP) should be followed up by two tests – an ultrasound of the fetal spine and amniocentesis of the mother’s amniotic fluid (to test for alpha-fetoprotein and acetylcholinesterase). AFP tests are now mandated by some state laws (including California). and failure to provide them can have legal ramifications. In one case a man born with spina bifida was awarded a $2 million settlement after court found his mother’s OBGYN negligent for not performing these tests. Spina bifida may be associated with other malformations as in dysmorphic syndromes, often resulting in spontaneous miscarriage. In the majority of cases, though, spina bifida is an isolated malformation.

Genetic counseling and further genetic testing, such as amniocentesis, may be offered during the pregnancy, as some neural tube defects are associated with genetic disorders such as trisomy 18. Ultrasound screening for spina bifida is partly responsible for the decline in new cases, because many pregnancies are terminated out of fear that a newborn might have a poor future quality of life. With modern medical care, the quality of life of patients has greatly improved.

Resources:
http://en.wikipedia.org/wiki/Spina_bifida
http://www.webmd.com/parenting/baby/tc/spina-bifida-topic-overview

Spirulina (Blue-green algae)

Other Names:
AFA, Algae, Algas Verdiazul, Algues Bleu-Vert, Algues Bleu-Vert du Lac Klamath, Anabaena, Aphanizomenon flos-aquae, Arthrospira maxima, Arthrospira platensis, BGA, Blue Green Algae, Blue-Green Micro-Algae, Cyanobacteria, Cyanobactérie, Cyanophycée, Dihe, Espirulina, Hawaiian Spirulina, Klamath, Klamath Lake Algae, Lyngbya wollei, Microcystis aeruginosa, Microcystis wesenbergii, Nostoc ellipsosporum, Spirulina Blue-Green Algae, Spirulina Fusiformis, Spirulina maxima, Spirulina platensis, Spirulina pacifica, Spiruline, Spiruline d’Hawaii, Tecuitlatl.

Description:
Spirulina is obtained from a plant in form of blue-green algae that springs from warm, fresh water bodies………..CLICK & SEE
Spirulina is a cyanobacterium that can be consumed by humans and other animals. There are two species, Arthrospira platensis and Arthrospira maxima.

Arthrospira is cultivated worldwide; used as a dietary supplement as well as a whole food; and is also available in tablet, flake and powder form. It is also used as a feed supplement in the aquaculture, aquarium and poultry industries.

Blue-green algae have a high protein, iron, and other mineral content which is absorbed when taken orally. Blue-green algae are being researched for their potential effects on the immune system, swelling (inflammation), and viral infections.

Chlorella is another form of algae that is sometimes confused with spirulina. The fundamental difference between spirulina and chlorella is that spirulina is many thousands of years older and does not possess the hard cell wall that makes chlorella closer to being a plant than algae.

Chlorella is an excellent way to detoxify  our body from mercury, which most of you are contaminated with if you’ve ever had dental fillings, received a vaccine, used certain types of cookware or eaten fish. Spirulina simply is unable to remove heavy metals like chlorella does, as it lacks a cell membrane.

Chlorella has also been proven to be of benefit to those who suffer from degenerative disease. This report, however, will focus on the specific benefits that can be attributed to spirulina in particular.

“Blue-green algae” describes a large and diverse group of simple, plant-like organisms found in salt water and some large fresh water lakes.

Blue-green algae products are used for many conditions, but so far, there isn’t enough scientific evidence to determine whether or not they are effective for any of them.

Blue-green algae are used as a source of dietary protein, B-vitamins, and iron. They are also used for weight loss, attention deficit-hyperactivity disorder (ADHD), hayfever, diabetes, stress, fatigue, anxiety, depression, and premenstrual syndrome (PMS) and other women’s health issues.

Some people use blue-green algae for treating precancerous growths inside the mouth, boosting the immune system, improving memory, increasing energy and metabolism, lowering cholesterol, preventing heart disease, healing wounds, and improving digestion and bowel health.

Blue-green algae are commonly found in tropical or subtropical waters that have a high-salt content, but some types grow in large fresh water lakes. The natural color of these algae can give bodies of water a dark-green appearance. The altitude, temperature, and sun exposure where the blue-green algae are grown dramatically influence the types and mix of blue-green algae in the water.

Some blue-green algae products are grown under controlled conditions. Others are grown in a natural setting, where they are more likely to be contaminated by bacteria, liver poisons (microcystins) produced by certain bacteria, and heavy metals. Choose only products that have been tested and found free of these contaminants.

You may have been told that blue-green algae are an excellent source of protein. But, in reality, blue-green algae is no better than meat or milk as a protein source and costs about 30 times as much per gram.

Protein:
Dried spirulina contains about 60% (51–71%) protein.  It is a complete protein containing all essential amino acids, though with reduced amounts of methionine, cysteine and lysine when compared to the proteins of meat, eggs and milk. It is, however, superior to typical plant protein, such as that from legumes.

The U.S. National Library of Medicine said that spirulina was no better than milk or meat as a protein source, and was approximately 30 times more expensive per gram

Other nutrients:
Spirulina’s lipid content is about 7% by weight,  and is rich in gamma-linolenic acid (GLA),  and also provides alpha-linolenic acid (ALA), linoleic acid (LA), stearidonic acid (SDA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA).  Spirulina contains vitamins B1 (thiamine), B2 (riboflavin), B3 (nicotinamide), B6 (pyridoxine), B9 (folic acid), vitamin C, vitamin A, and vitamin E.  It is also a source of potassium, calcium, chromium, copper, iron, magnesium, manganese, phosphorus, selenium, sodium, and zinc. Spirulina contains many pigments which may be beneficial and bioavailable, including beta-carotene,  zeaxanthin,  7-hydroxyretinoic acid,  isomers, chlorophyll-a, xanthophyll, echinenone, myxoxanthophyll, canthaxanthin, diatoxanthin, 3′-hydroxyechinenone, beta-cryptoxanthin, and oscillaxanthin, plus the phycobiliproteins  c-phycocyanin and allophycocyanin.

Vitamin B12 controversy:
Spirulina is not considered to be a reliable source of Vitamin B12. Spirulina supplements contain predominantly pseudovitamin B12, which is biologically inactive in humans. Companies which grow and market spirulina have claimed it to be a significant source of B12 on the basis of alternative, unpublished assays, although their claims are not accepted by independent scientific organizations. The American Dietetic Association and Dietitians of Canada in their position paper on vegetarian diets state that spirulina cannot be counted on as a reliable source of active vitamin B12. The medical literature similarly advises that spirulina is unsuitable as a source of B12.

 Spirulina Helped Save Millions from Arsenic Poisoning:
Bangladeshi researchers conducted a three-month-hospital-based study, where spirulina was given to 33 patients while 17 received placebo doses. 82 percent of those taking spirulina showed tremendous improvement.

An Immune-System Power-Boost — Spirulina’s Impact on Candida and AIDS:
According to a study done by the Department of Aquataculture in Taiwan,4 spirulina shows significant immune-boosting properties. Researchers exposed white shrimp to seawater containing a hot-water extract of spirulina before transferring them to seawater with a pH level of 6.8. The control group was not exposed to spirulina.

The shrimp exposed to the spirulina seawater showed a faster and more promising recovery rate to the high levels of pH than those not given the dose of spirulina first.

Now, let’s take a look at what this immune-system boosting power can mean for  us:

Candida:
If  we have an autoimmune disease such as Crohn’s disease, chronic fatigue syndrome, Lupus or fibromyalgia, chronic candida yeast can both cause and worsen your symptoms. Spirulina has been shown to encourage and support the growth of healthy bacterial flora in our gut,  which can help keep candida overgrowth under control.

HIV and AIDS:
Drugs such as AZT used to treat HIV and AIDS patients can actually cause the symptoms they are supposed to cure. However, spirulina has been shown to help inactivate the human immunodeficiency virus associated with HIV and AIDS.

Seasonal Allergy:
Millions of people are allergic to pollen, ragweed, dust, mold, pet dander, and a myriad other environmental contaminants, ensuring the makers of Kleenex will always stay in business.

Unfortunately, many people who have allergic rhinitis treat it with prescription and over-the-counter (OTC) drugs that often do more harm than good. Antihistamines are designed to suppress our immune system, which leads to decreased resistance to disease and dependence on the drug. Certain asthma drugs have been linked to serious side effects as well.

This is where natural methods such as the use of spirulina come in. According to one study,  patients treated with spirulina reported relief of symptoms commonly associated with allergic rhinitis, such as nasal discharge and congestion, sneezing and itching, when given spirulina.

Blood Pressure Balancing:
According to a study done by the Department of Biochemistry in Mexico,7 4.5 grams of spirulina given each day was shown to regulate blood pressure among both women and men ages 18-65 years with no other dietary changes made during the six weeks the experiment was run.

Lowers Stroke Risk:
In a study done at the Institute of Pharmaceutical Technology in India, it was found that a dosage of 180mg/kg of spirulina had a protective effect on the brain and nervous system of rats exposed to high amounts of free radicals, compared to rats not given the spirulina before the experiment. This lab test shows the promising effect of spirulina on stroke prevention.

Helps Reduce Cancer Risk:
According to a study done in China,10 selenium-infused spirulina inhibited the growth of MCF-7 breast cancer cells.

Potential Adverse Reactions:
Spirulina is a safe source of protein, nutrients, vitamins, and minerals that has been used for centuries. Though there are no known side effects associated with spirulina,  our body may react to it based on  our current state of health. Let’s take a look at some of those reactions,  what they mean, and what you can do to alleviate them.

The most prominent reactions  one may experience are:
*Slight Fever –– The high protein content in spirulina increases metabolism, which may elevate body temperature.

*Dark Green Waste Matter — Spirulina can remove accumulated waste product in our colon, which may cause darker stool. Also, spirulina is high in chlorophyll. This will also turn waste matter green.

*Excessive Passing of Gas — This may indicate that your digestive system is not functioning properly or you have an extreme build-up of gas.

*Feelings of Excitement — Our body is converting protein into heat energy, which may cause temporary feelings of restlessness.

*Breakouts and Itchy Skin — This is caused by colon cleansing process and is only temporary.

*Sleepiness — This is caused by the detoxification process and may indicate our body is exhausted and needs better rest.

Remember, our body may go through an adjustment period with spirulina, and our best bet to reduce reaction is to dose gradually to see how  our body will react.  Water intake should be increased and ,  stress levels should be  reduced, we should eat according to our nutritional type, and get plenty of rest.

Important Contraindications for Spirulina:
Even though spirulina is entirely natural and generally considered a healthful food, there are some contraindications  we need to be aware of.  No one should  take spirulina if he or she has a severe seafood or iodine allergy. And, if one is pregnant or nursing or have hyperthyroidism, it is adviced  to  consult with the healthcare provider before taking spirulina.

Resources:
http://en.wikipedia.org/wiki/Spirulina_(dietary_supplement)
http://www.webmd.com/vitamins-supplements/ingredientmono-923-spirulina%20(blue-green%20algae).aspx?activeingredientid=923&activeingredientname=spirulina%20(blue-green%20algae)
http://articles.mercola.com/sites/articles/archive/2011/07/01/spirulina-the-amazing-super-food-youve-never-heard-of.aspx

Cognitive Behavioural Therapy (CBT)

Definition:
Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders including phobias, addictions, depression, and anxiety.

CLICK & SEE

Cognitive behavioral therapy (CBT) is a short-term psychotherapy originally designed to treat depression, but is now used for a number of mental illnesses. It works to solve current problems and change unhelpful thinking and behavior.  The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles.  Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems),  or directive in its therapeutic approach.

CBT has been demonstrated to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders. Many CBT treatment programs for specific disorders have been evaluated for efficacy; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments.  However, other researchers have questioned the validity of such claims to superiority over other treatments.

Description:
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in affect and behavior,[8] but recent variants emphasize changes in one’s relationship to maladaptive thinking rather than changes in thinking itself.  Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace “errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior.”  These errors in thinking are known as cognitive distortions. Cognitive distortions can be either a pseudo- discrimination belief or an over-generalization of something.  CBT techniques may also be used to help individuals take a more open, mindful, and aware posture toward them so as to diminish their impact. Mainstream CBT helps individuals replace “maladaptive… coping skills, cognitions, emotions and behaviors with more adaptive ones”,  by challenging an individual’s way of thinking and the way that they react to certain habits or behaviors,  but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with CBT over and above the earlier behavioral elements such as exposure and skills training.

Modern forms of CBT include a number of diverse but related techniques such as exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy.  Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.

CBT has six phases:
1.Assessment or psychological assessment;
2.Reconceptualization;
3.Skills acquisition;
4.Skills consolidation and application training;
5.Generalization and maintenance;
6.Post-treatment assessment follow-up.

The reconceptualization phase makes up much of the “cognitive” portion of CBT.   A summary of modern CBT approaches is given by Hofmann.

There are different protocols for delivering cognitive behavioral therapy, with important similarities among them.  Use of the term CBT may refer to different interventions, including “self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting”. Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven. CBT is used in both individual and group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are cognitively oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (e.g. in vivo exposure therapy). Interventions such as imaginal exposure therapy combine both approaches.

Types of Cognitive Behavior Therapy:
There are a number of different approaches to CBT that are regularly used by mental health professionals. These types include:
•Rational Emotive Behavior Therapy (REBT)
•Cognitive Therapy
•Multimodal Therapy

Medical uses of CBT:
In adults, CBT has been shown to have effectiveness and a role in the treatment plans for anxiety disorders,  depressioneating disorders chronic low back painpersonality disorderspsychosis,  schizophrenia,  substance use disorders,  in the adjustment, depression, and anxiety associated with fibromyalgia,  and with post-spinal cord injuries.  Evidence has shown CBT is effective in helping treat schizophrenia, and it is now offered in most treatment guidelines.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders,  body dysmorphic disorder,  depression and suicidality,  eating disorders and obesity,  obsessive–compulsive disorder,  and posttraumatic stress disorder,  as well as tic disorders, trichotillomania, and other repetitive behavior disorders.

Cochrane reviews have found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition.   Other recent Cochrane Reviews found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care,  nor was it helpful in treating men who abuse their intimate partners.

According to a 2004 review by INSERM of three methods, cognitive behavioral therapy was either “proven” or “presumed” to be an effective therapy on several specific mental disorders.  According to the study, CBT was effective at treating schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependency.

Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression.  However, psychodynamic therapy may provide better long-term outcomes.

Computerized CBT (CCBT) has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders, including children,  as well as insomnia.  Some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls.  CCBT was found to be equally effective as face-to-face CBT in adolescent anxiety  and insomnia.

Criticism of CBT sometimes focuses on implementations (such as the UK IAPT) which may result initially in low quality therapy being offered by poorly trained practitioners.  However evidence supports the effectiveness of CBT for anxiety and depression.

Mounting evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues.

CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality conditions and behavioral problems.  A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.”

Emerging evidence suggests a possible role for CBT in the treatment of attention deficit hyperactivity disorder (ADHD);  hypochondriasis;  coping with the impact of multiple sclerosis;  sleep disturbances related to aging; dysmenorrhea;  and bipolar disorder,  but more study is needed and results should be interpreted with caution. CBT has been studied as an aid in the treatment of anxiety associated with stuttering. Initial studies have shown CBT to be effective in reducing social anxiety in adults who stutter,  but not in reducing stuttering frequency.

Martinez-Devesa et al. (2010) found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition. Turner et al. (2007) found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care,[39] and Smedslund et al. (2007) found that it was not helpful in treating men who abuse their intimate partners.

In the case of metastatic breast cancer, Edwards et al. (2008) maintained that the current body of evidence is not sufficient to rule out the possibility that psychological interventions may cause harm to women with this advanced neoplasm.

In adults, CBT has been shown to have a role in the treatment plans for anxiety disorders; depression;  eating disorders;  chronic low back pain;  personality disorders;  psychosis; schizophrenia;  substance use disorders;  in the adjustment, depression, and anxiety associated with fibromyalgia;  and with post-spinal cord injuries.  There is some evidence that CBT is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia.  CBT has been shown to be moderately effective for treating chronic fatigue syndrome.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders;  body dysmorphic disorder;  depression and suicidality;  eating disorders and obesity;  obsessive–compulsive disorder;  and posttraumatic stress disorder;  as well as tic disorders, trichotillomania, and other repetitive behavior disorders. CBT-SP, an adaptation of CBT for suicide prevention (SP), was specifically designed for treating youth who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable. Sparx is a video game to help young persons, using the CBT method to teach them how to resolve their own issues. That’s a new way of therapy, which is quite effective for child and teenager. CBT has also been shown to be effective for posttraumatic stress disorder in very young children (3 to 6 years of age).  Cognitive Behavior Therapy has also been applied to a variety of childhood disorders,  including depressive disorders and various anxiety disorders.

In the United Kingdom, the National Institute for Health and Care Excellence (NICE) recommends CBT in the treatment plans for a number of mental health difficulties, including posttraumatic stress disorder, obsessive–compulsive disorder (OCD), bulimia nervosa, and clinical depression

Use of CBT  in other different ways:
With older adults:
CBT is used to help people of all ages, but the therapy should be adjusted based on the age of the patient with whom the therapist is dealing. Older individuals in particular have certain characteristics that need to be acknowledged and the therapy altered to account for these differences thanks to age.   Some of the challenges to CBT because of age include the following:
The Cohort effect The times that each generation lives through partially shape its thought processes as well as values, so a 70-year-old may react to the therapy very differently from a 30-year-old, because of the different culture in which they were brought up. A tie-in to this effect is that each generation has to interact with one another, and the differing values clashing with one another may make the therapy more difficult.  Established role By the time one reaches old age, the person has a definitive idea of her or his role in life and is invested in that role. This social role can dominate who the person thinks he or she is and may make it difficult to adapt to the changes required in CBT. Mentality toward aging If the older individual sees aging itself as a negative this can exacerbate whatever malady the therapy is trying to help (depression and anxiety for example).  Negative stereotypes and prejudice against the elderly cause depression as the stereotypes become self-relevant.[88]Processing speed decreasesAs we age, we take longer to learn new information, and as a result may take more time to learn and retain the cognitive therapy. Therefore, therapists should slow down the pacing of the therapy and use any tools both written and verbal that will improve the retention of the cognitive behavioral therapy.

Prevention of mental illness:
For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.  In another study, 3% of the group receiving the CBT intervention developed generalized anxiety disorder by 12 months post intervention compared with 14% in the control group.  Subthreshold panic disorder sufferers were found to significantly benefit from use of CBT.  Use of CBT was found to significantly reduce social anxiety prevalence.

For depressive disorders, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older.  Another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles.[99] A further study also saw a neutral result. A meta-study of the Coping with Depression course, a cognitive behavioural intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression.

For schizophrenia, one study of preventative CBT showed a positive effect   and another showed neutral effect.

Criticisms of Cognitive Behavior Therapy:
The research conducted for CBT has been a topic of sustained controversy. While some researchers write that CBT is more effective than other treatments,[148] many other researchers  and practitioners  have questioned the validity of such claims. For example, one study  determined CBT to be superior to other treatments in treating anxiety and depression. However, researchers responding directly to that study conducted a re-analysis and found no evidence of CBT being superior to other bona fide treatments, and conducted an analysis of thirteen other CBT clinical trials and determined that they failed to provide evidence of CBT superiority.

Furthermore, other researchers  write that CBT studies have high drop-out rates compared to other treatments. At times, the CBT drop-out rates can be more than five times higher than other treatments groups. For example, the researchers provided statistics of 28 participants in a group receiving CBT therapy dropping out, compared to 5 participants in a group receiving problem-solving therapy dropping out, or 11 participants in a group receiving psychodynamic therapy dropping out.

Other researchers  conducting an analysis of treatments for youth who self-injure found similar drop-out rates in CBT and DBT groups. In this study, the researchers analyzed several clinical trials that measured the efficacy of CBT administered to youth who self-injure. The researchers concluded that none of them were found to be efficacious. These conclusions  were made using the APA Division 12 Task Force on the Promotion and Dissemination of Psychological Procedures to determine intervention potency.

However, the research methods employed in CBT research have not been the only criticisms identified. Others have called CBT theory and therapy into question. For example, Fancher  writes the CBT has failed to provide a framework for clear and correct thinking. He states that it is strange for CBT theorists to develop a framework for determining distorted thinking without ever developing a framework for “cognitive clarity” or what would count as “healthy, normal thinking.” Additionally, he writes that irrational thinking cannot be a source of mental and emotional distress when there is no evidence of rational thinking causing psychological well-being. Or, that social psychology has proven the normal cognitive processes of the average person to be irrational, even those who are psychologically well. Fancher also says that the theory of CBT is inconsistent with basic principles and research of rationality, and even ignores many rules of logic. He argues that CBT makes something of thinking that is far less exciting and true than thinking probably is. Among his other arguments are the maintaining of the status quo promoted in CBT, the self-deception encouraged within clients and patients engaged in CBT, how poorly the research is conducted, and some of its basic tenets and norms: “The basic norm of cognitive therapy is this: except for how the patient thinks, everything is ok”.

Meanwhile, Slife and Williams  write that one of the hidden assumptions in CBT is that of determinism, or the absence of free will. They argue that CBT invokes a type of cause-and-effect relationship with cognition. They state that CBT holds that external stimuli from the environment enter the mind, causing different thoughts that cause emotional states. Nowhere in CBT theory is agency, or free will, accounted for. At its most basic foundational assumptions, CBT holds that human beings have no free will and are just determined by the cognitive processes invoked by external stimuli.

Another criticism of CBT theory, especially as applied to Major Depressive Disorder (MDD), is that it confounds the symptoms of the disorder with its causes.

A major criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, i.e. the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.

The importance of double-blinding was shown in a meta-analysis that examined the effectiveness of CBT when placebo control and blindedness were factored in.[156] Pooled data from published trials of CBT in schizophrenia, MDD, and bipolar disorder that used controls for non-specific effects of intervention were analyzed. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates, treatment effects are small in treatment studies of MDD, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder. For MDD, the authors note that the pooled effect size was very low. Nevertheless, the methodological processes used to select the studies in the previously mentioned meta-analysis and the worth of its findings have been called into question.

Resources:
http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
http://psychology.about.com/od/psychotherapy/a/cbt.htm

Aphasia

Description:
Aphasia is the name given to a collection of language disorders caused by damage to the brain.  The word aphasia comes from the wordn aphasia, in Ancient Greek, which means A requirement for a diagnosis of aphasia is that, prior to the illness or injury, the person’s language skills were normal . The difficulties of people with aphasia can range from occasional trouble finding words to losing the ability to speak, read, or write, but does not affect intelligence. This also affects visual language such as sign language. The term “aphasia” implies a problem with one or more functions that are essential and specific to language function. It is not usually used when the language problem is a result of a more peripheral motor or sensory difficulty, such as paralysis affecting the speech muscles or a general hearing impairment.
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Stroke is the most common cause of aphasia in the United States. Approximately 500,000 individuals suffer strokes each year, and 20% of these individuals develop some type of aphasia. Other causes of brain damage include head injuries, brain tumors, and infection. About half of the people who show signs of aphasia have what is called temporary or transient aphasia and recover completely within a few days. An estimated one million Americans suffer from some form of permanent aphasia. As yet, no connection between aphasia and age, gender, or race has been found.
Aphasia is sometimes confused with other conditions that affect speech, such as dysarthria and apraxia. These condition affect the muscles used in speaking rather than language function itself. Dysarthria is a speech disturbance caused by lack of control over the muscles used in speaking, perhaps due to nerve damage. Speech apraxia is a speech disturbance in which language comprehension and muscle control are retained, but the memory of how to use the muscles to form words is not.

Symptoms:
Aphasia is condition characterized by either partial or total loss of the ability to communicate verbally or using written words. A person with aphasia may have difficulty speaking, reading, writing, recognizing the names of objects, or understanding what other people have said. Aphasia is caused by a brain injury, as may occur during a traumatic accident or when the brain is deprived of oxygen during a stroke. It may also be caused by a brain tumor, a disease such as Alzheimer’s, or an infection, like encephalitis. Aphasia may be temporary or permanent. Aphasia does not include speech impediments caused by loss of muscle control.
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To understand and use language effectively, an individual draws upon word memory-stored information on what certain words mean, how to put them together, and how and when to use them properly. For a majority of people, these and other language functions are located in the left side (hemisphere) of the brain. Damage to this side of the brain is most commonly linked to the development of aphasia. Interestingly, however, left-handed people appear to have language areas in both the left and right hemispheres of the brain and, as a result, may develop aphasia from damage to either side of the brain.

People with aphasia may experience any of the following behaviors due to an acquired brain injury, although some of these symptoms may be due to related or concomitant problems such as dysarthria or apraxia and not primarily due to aphasia. Aphasia symptoms can vary based on the location of damage in the brain. Signs and symptoms may or may not be present in individuals with aphasia and may vary in severity and level of disruption to communication. Often those with aphasia will try to hide their inability to name objects by using words like thing. So when asked to name a pencil they may say it is a thing used to write.

*inability to comprehend language
*inability to pronounce, not due to muscle paralysis or weakness
*inability to speak spontaneously
*inability to form words
*inability to name objects (anomia)
*poor enunciation
*excessive creation and use of personal neologisms
*inability to repeat a phrase
*persistent repetition of one syllable, word, or phrase (stereotypies)
*paraphasia (substituting letters, syllables or words)
*agrammatism (inability to speak in a grammatically correct fashion)
*dysprosody (alterations in inflexion, stress, and rhythm)
*incomplete sentences
*inability to read
*inability to write
*limited verbal output
*difficulty in naming
*speech disorder
*Speaking gibberish
*inability to follow or understand simple requests

Causes:
Aphasia is most commonly caused by stroke. It can also be caused by other brain diseases, including cancer (brain tumor), epilepsy, and Alzheimer’s disease, or by a head injury. In rare cases, aphasia may also result from herpesviral encephalitis. The herpes simplex virus affects the frontal and temporal lobes, subcortical structures, and the hippocampal tissue, which can trigger aphasia. In acute disorders, such as head injury or stroke, aphasia usually develops quickly. Aphasia usually develops more slowly from a brain tumor, infection, or dementia.

Although all of the disease listed above are potential causes, aphasia will generally only result when there is substantial damage to the left hemisphere of the brain, either the cortex (outer layer) and/or the underlying white matter. Substantial damage to tissue anywhere within the region shown in blue on the figure below can potentially result in aphasia.  Aphasia can also sometimes be caused by damage to subcortical structures deep within the left hemisphere, including the thalamus, the internal and external capsules, and the caudate nucleus of the basal ganglia.  The area and extent of brain damage or atrophy will determine the type of aphasia and its symptoms.  A very small number of people can experience aphasia after damage to the right hemisphere only. It has been suggested that these individuals may have had an unusual brain organization prior to their illness or injury, with perhaps greater overall reliance on the right hemisphere for language skills than in the general population.

Finally, certain chronic neurological disorders, such as epilepsy or migraine, can also include transient aphasia as a prodromal or episodic symptom.  Aphasia is also listed as a rare side-effect of the fentanyl patch, an opioid used to control chronic pain.

Classification:
Aphasia is best thought of as a collection of different disorders, rather than a single problem. Each individual with aphasia will present with their own particular combination of language strengths and weaknesses. Consequently, it is a major challenge just to document the various difficulties that can occur in different people, let alone decide how they might best be treated. Most classifications of the aphasias tend to divide the various symptoms into broad classes. A common approach is to distinguish between the fluent aphasias (where speech remains fluent, but content may be lacking, and the person may have difficulties understanding others), and the nonfluent aphasias ( where speech is very halting and effortful, and may consist of just one or two words at a time).

However, no such broad-based grouping has proven fully adequate. There is a huge variation among patients within the same broad grouping, and aphasias can be highly selective. For instance, patients with naming deficits (anomic aphasia) might show an inability only for naming buildings, or people, or colors.

Classical-Localizationist approaches:
Localizationist approaches aim to classify the aphasias according to their major presenting characteristics and the regions of the brain that most probably gave rise to them. Inspired by the early work of nineteenth century neurologists Paul Broca and Carl Wernicke, these approaches identify two major subtypes of aphasia and several more minor subtypes:

*Broca’s aphasia (also known as Motor aphasia or Expressive aphasia), which is characterized by halted, fragmented, effortful speech, but relatively well-preserved comprehension. It has been associated with damage to the posterior left prefrontal cortex, most notably Broca’s area. Individuals with Broca’s aphasia often have right-sided weakness or paralysis of the arm and leg, because the left frontal lobe is also important for body movement, particularly on the right side.

*Wernicke’s aphasia (also known as Sensory aphasia or Receptive aphasia), which is characterized by fluent speech, but marked difficulties understanding words and sentences. Although fluent, the speech may lack in key substantive words (nouns, verbs adjectives), and may contain incorrect words or even nonsense words. This subtype has been associated with damage to the posterior left temporal cortex, most notably Wernicke’s area. These individuals usually have no body weakness, because their brain injury is not near the parts of the brain that control movement.

*Other, more minor subtypes include Conduction aphasia, a disorder where speech remains fluent, and comprehension is preserved, but the person may have disproportionate difficulty where repeating words or sentences. Other include Transcortical motor aphasia and Transcortical sensory aphasia which are similar to Broca’s and Wernicke’s aphasia respectively, but the ability to repeat words and sentences is disroportionately preserved.

Recent classification schemes adopting this approach, such as the “Boston-Neoclassical Model”  also group these classical aphasia subtypes into two larger classes: the nonfluent aphasias (which encompasses Broca’s aphasia and transcortical motor aphasia) and the fluent aphasias (which encompasses Wernicke’s aphasia, conduction aphasia and transcortical sensory aphasia). These schemes also identify several further aphasia subtypes, including: Anomic aphasia, which is characterized by a selective difficulty finding the names for things; and Global aphasia where both expression and comprehension of speech are severely compromised.

Many localizationist approaches also recognize the existence of additional, more “pure” forms of language disorder that may affect only a single language skill.  For example, in Pure alexia, a person may be able to write but not read, and in Pure word deafness, they may be able to produce speech and to read, but not understand speech when it is spoken to them.

Cognitive neuropsychological approaches:
Although localizationist approaches provide a useful way of classifying the different patterns of language difficulty into broad groups, one problem is that a sizeable number of individuals do not fit neatly into one category or another. Another problem is that the categories, particularly the major ones such as Broca’s and Wernicke’s aphasia, still remain quite broad. Consequently, even amongst individuals who meet the criteria for classification into a subtype, there can be enormous variability in the types of difficulties they experience.

Instead of categorizing every individual into a specific subtype, cognitive neuropsychological approaches aim to identify the key language skills or “modules” that are not functioning properly in each individual. A person could potentially have difficulty with just one module, or with a number of modules. This type of approach requires a framework or theory as to what skills/modules are needed to perform different kinds of language tasks. For example, the model of Max Coltheart identifies a module that recognizes phonemes as they are spoken, which is essential for any task involving recognition of words. Similarly, there is a module that stores phonemes that the person is planning to produce in speech, and this module is critical for any task involving the production of long words or long strings of speech. One a theoretical framework has been established, the functioning of each module can then be assessed using a specific test or set of tests. In the clinical setting, use of this model usually involves conducting a battery of assessments, each of which tests one or a number of these modules. Once a diagnosis is reached as to the skills/modules where the most significant impairment lies, therapy can proceed to treat these skills.

In practice, the cognitive neuropsychological approach can be unwieldy due to the wide variety of skills that can potentially be tested. Also, it is perhaps best suited to milder cases of aphasia: If the person has little expressive or receptive language ability, sometimes test performance can be difficult to interpret. In practice, clinicians will often use a blend of assessment approaches, which include broad subtyping based on a localizationist framework, and some finer exploration of specific language skills based on the cognitive neuropsychological framework.
Other forms of aphasia:

Progressive aphasias:
Primary progressive aphasia (PPA) is associated with progressive illnesses or dementia, such as frontotemporal dementia / Pick Complex Motor neuron disease, Progressive supranuclear palsy, and Alzheimer’s disease, which is the gradual process of progressively losing the ability to think. It is characterized by the gradual loss of the ability to name objects. People suffering from PPA may have difficulties comprehending what others are saying. They can also have difficulty trying to find the right words to make a sentence. There are three classifications of Primary Progressive Aphasia : Progressive nonfluent aphasia (PNFA), Semantic Dementia (SD), and Logopenic progressive aphasia (LPA)

Progressive Jargon Aphasia is a fluent or receptive aphasia in which the patient’s speech is incomprehensible, but appears to make sense to them. Speech is fluent and effortless with intact syntax and grammar, but the patient has problems with the selection of nouns. Either they will replace the desired word with another that sounds or looks like the original one or has some other connection or they will replace it with sounds. As such, patients with jargon aphasia often use neologisms, and may perseverate if they try to replace the words they cannot find with sounds. Substitutions commonly involve picking another (actual) word starting with the same sound (e.g., clocktower – colander), picking another semantically related to the first (e.g., letter – scroll), or picking one phonetically similar to the intended one (e.g., lane – late).

Deaf aphasia:
There have been many instances showing that there is a form of aphasia among deaf individuals. Sign language is, after all, a form of communication that has been shown to use the same areas of the brain as verbal forms of communication. Mirror neurons become activated when an animal is acting in a particular way or watching another individual act in the same manner. These mirror neurons are important in giving an individual the ability to mimic movements of hands. Broca’s area of speech production has been shown to contain several of these mirror neurons resulting in significant similarities of brain activity between sign language and vocal speech communication. Facial communication is a significant portion of how animals interact with each other. Humans use facial movements to create, what other humans perceive, to be faces of emotions. While combining these facials movements with speech, a more full form of language is created which enables the species to interact with a much more complex and detailed form of communication. Sign language also uses these facial movements and emotions along with the primary hand movement way of communicating. These facial movement forms of communication come from the same areas of the brain. When dealing with damages to certain areas of the brain, vocal forms of communication are in jeopardy of severe forms of aphasia. Since these same areas of the brain are being used for sign language, these same, at least very similar, forms of aphasia can show in the Deaf community. Individuals can show a form of Wernicke’s aphasia with sign language and they show deficits in their abilities in being able to produce any form of expressions. Broca’s aphasia shows up in some patients, as well. These individuals find tremendous difficulty in being able to actually sign the linguistic concepts they are trying to express

Diagnosis:
Following brain injury, an initial bedside assessment is made to determine whether language function has been affected. If the individual experiences difficulty communicating, attempts are made to determine whether this difficulty arises from impaired language comprehension or an impaired ability to speak. A typical examination involves listening to spontaneous speech and evaluating the individual’s ability to recognize and name objects, comprehend what is heard, and repeat sample words and phrases. The individual may also be asked to read text aloud and explain what the passage means. In addition, writing ability is evaluated by having the individual copy text, transcribe dictated text, and write something without prompting.
A speech pathologist or neuropsychologist may be asked to conduct more extensive examinations using in-depth, standardized tests. Commonly used tests include the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, and possibly, the Porch Index of Speech Ability.

The results of these tests indicate the severity of the aphasia and may also provide information regarding the exact location of the brain damage. This more extensive testing is also designed to provide the information necessary to design an individualized speech therapy program. Further information about the location of the damage is gained through the use of imaging technology, such as magnetic resonance imaging (MRI) and computed tomography scans.
Treatment:
Initially, the underlying cause of aphasia must be treated or stabilized. To regain language function, therapy must begin as soon as possible following the injury. Although there are no medical or surgical procedures currently available to treat this condition, aphasia resulting from stroke or head injury may improve through the use of speech therapy. For most individuals, however, the primary emphasis is placed on making the most of retained language abilities and learning to use other means of communication to compensate for lost language abilities.
Speech therapy is tailored to meet individual needs, but activities and tools that are frequently used include the following:

Exercise and practice. Weakened muscles are exercised by repetitively speaking certain words or making facial expressions, such as smiling.
Picture cards. Pictures of everyday objects are used to improve word recall and increase vocabulary. The names of the objects may also be repetitively spoken aloud as part of an exercise and practice routine.

Picture boards. Pictures of everyday objects and activities are placed together, and the individual points to certain pictures to convey ideas and communicate with others.
Workbooks. Reading and writing exercises are used to sharpen word recall and regain reading and writing abilities. Hearing comprehension is also redeveloped using these exercises.
Computers. Computer software can be used to improve speech, reading, recall, and hearing comprehension by, for example, displaying pictures and having the individual find the right word.

Prognosis:
The degree to which an individual can recover language abilities is highly dependent on how much brain damage occurred and the location and cause of the original brain injury. Other factors include the individual’s age, general health, motivation and willingness to participate in speech therapy, and whether the individual is left or right handed. Language areas may be located in both the left and right hemispheres in left-handed individuals. Left-handed individuals are, therefore, more likely to develop aphasia following brain injury, but because they have two language centers, may recover more fully because language abilities can be recovered from either side of the brain. The intensity of therapy and the time between diagnosis and the start of therapy may also affect the eventual outcome.

Prevention:
Because there is no way of knowing when a stroke, traumatic head injury, or disease will occur, very little can be done to prevent aphasia. However  it can be adviced to be careful in movement of aged person specially for those having high bloodpressure, diabetis and other form of diseases.

Following are some precautions that should be taken to avoid aphasia, by decreasing the risk of stroke, the main cause of aphasia:

*Exercising regularly
*Eating a healthy diet
*Keeping alcohol consumption low and avoiding tobacco use
*Controlling blood pressure

History:
The first recorded case of aphasia is from an Egyptian papyrus, the Edwin Smith Papyrus, which details speech problems in a person with a traumatic brain injury to the temporal lobe.During the second half of the 19th century, Aphasia was a major focus for scientists and philosophers who were working in the beginning stages in the field of psychology.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Aphasia
http://medical-dictionary.thefreedictionary.com/aphasia

Music Therapy

Definition:
Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

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Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients’ abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people’s motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings.

Music therapy is the use of interventions to accomplish individual goals within a therapeutic relationship by a professional who has completed an approved music therapy program. Music therapy is an allied health profession and one of the expressive therapies, consisting of a process in which a music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients improve their physical and mental health. Music therapists primarily help clients improve their health in several domains, such as cognitive functioning, motor skills, emotional development, social skills, and quality of life, by using music experiences such as free improvisation, singing, and listening to, discussing, and moving to music to achieve treatment goals. It has a wide qualitative and quantitative research literature base and incorporates clinical therapy, psychotherapy, biomusicology, musical acoustics, music theory, psychoacoustics, embodied music cognition, aesthetics of music, sensory integration, and comparative musicology. Referrals to music therapy services may be made by other health care professionals such as physicians, psychologists, physical therapists, and occupational therapists. Clients can also choose to pursue music therapy services without a referral (i.e., self-referral).

Music therapists are found in nearly every area of the helping professions. Some commonly found practices include developmental work (communication, motor skills, etc.) with individuals with special needs, songwriting and listening in reminiscence/orientation work with the elderly, processing and relaxation work, and rhythmic entrainment for physical rehabilitation in stroke victims. Music therapy is also used in some medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and correctional facilities.
History:
Music has been used as a healing implement for centuries. Apollo is the ancient Greek god of music and of medicine. Aesculapius was said to cure diseases of the mind by using song and music, and music therapy was used in Egyptian temples. Plato said that music affected the emotions and could influence the character of an individual. Aristotle taught that music affects the soul and described music as a force that purified the emotions. Aulus Cornelius Celsus advocated the sound of cymbals and running water for the treatment of mental disorders. Music therapy was practiced in biblical times, when David played the harp to rid King Saul of a bad spirit. As early as 400 B.C., Hippocrates played music for mental patients. In the thirteenth century, Arab hospitals contained music-rooms for the benefit of the patients. In the United States, Native American medicine men often employed chants and dances as a method of healing patients. The Turco-Persian psychologist and music theorist al-Farabi (872–950), known as Alpharabius in Europe, dealt with music therapy in his treatise Meanings of the Intellect, in which he discussed the therapeutic effects of music on the soul. Robert Burton wrote in the 17th century in his classic work, The Anatomy of Melancholy, that music and dance were critical in treating mental illness, especially melancholia. Music therapy as we know it began in the aftermath of World Wars I and II, when, particularly in the United Kingdom, musicians would travel to hospitals and play music for soldiers suffering from war-related emotional and physical trauma.

Approaches:
Approaches used in music therapy that have emerged from the field of education include Orff-Schulwerk (Orff), Dalcroze Eurhythmics, and Kodaly. Models that developed directly out of music therapy are Neurologic Music Therapy (NMT), Nordoff-Robbins and the Bonny Method of Guided Imagery and Music.

Music therapists may work with individuals who have behavioral-emotional disorders. To meet the needs of this population, music therapists have taken current psychological theories and used them as a basis for different types of music therapy. Different models include behavioral therapy, cognitive behavioral therapy, and psychodynamic therapy.

One therapy model based on neuroscience, called “neurological music therapy” (NMT), is “based on a neuroscience model of music perception and production, and the influence of music on functional changes in non-musical brain and behavior functions. In other words, NMT studies how the brain is without music, how the brain is with music, measures the differences, and uses these differences to cause changes in the brain through music that will eventually affect the client non-musically. As one researcher, Dr. Thaut, said: “The brain that engages in music is changed by engaging in music.” NMT trains motor responses (i.e. tapping foot or fingers, head movement, etc.) to better help clients develop motor skills that help “entrain the timing of muscle activation patterns.

Music therapy approaches used with Children:
Paul Nordoff, a Juilliard School graduate and Professor of Music, was a gifted pianist and composer who, upon seeing disabled children respond so positively to music, gave up his academic career to further investigate the possibility of music as a means for therapy. Dr. Clive Robbins, a special educator, partnered with Nordoff for over 17 years in the exploration and research of music’s effects on disabled children- first in the United Kingdom, and then in the USA in the 1950s and 60s. Their pilot projects included placements at care units for autistic children and child psychiatry departments, where they put programs in place for children with mental disorders, emotional disturbances, developmental delays, and other handicaps. Their success at establishing a means of communication and relationship with autistic children at the University of Pennsylvania gave rise to the National Institutes of Health’s first grant given of this nature, and the 5-year study “Music Therapy Project for Psychotic Children Under Seven at the Day Care Unit” involved research, publication, training and treatment. Several publications, including Therapy in Music for Handicapped Children, Creative Music Therapy, Music Therapy in Special Education, as well as instrumental and song books for children, were released during this time. Nordoff and Robbins’s success became known globally in the mental health community, and they were invited to share their findings and offer training on an international tour that lasted several years. Funds were granted to support the founding of the Nordoff Robbins Music Therapy Centre in Great Britain in 1974, where a one-year Graduate program for students was implemented. In the early eighties, a center was opened in Australia, and various programs and institutes for Music Therapy were founded in Germany and other countries. In the United States, the Nordoff-Robbins Center for Music Therapy was established at New York University in 1989.

The Nordoff-Robbins approach, based on the belief that everyone is capable of finding meaning in and benefitting from musical experience, is now practiced by hundreds of therapists internationally. It focuses on treatment through the creation of music by both therapist and client together. Various techniques are used to accommodate all capabilities so that even the most low functioning individuals are able to participate actively.

Assessment and interventions :
As with any type of therapy, the practice of Music Therapy with children must uphold standards of conduct and ethics, agreed upon by national and provincial associations such as the Canadian Association for Music Therapy. In part with this, formal assessment is crucial for understanding the child – their background, limitations and needs, as well as to create appropriate goals for the process and select the means of achieving them. This serves as the starting point from which to measure the client’s progression throughout the therapeutic process and to make adjustments later, if necessary. Similarly to how assessments are conducted with adults, the music therapist obtains extensive data on the client including their full medical history, musical (ability to duplicate a melody or identify changes in rhythm, etc.) and nonmusical functioning (social, physical/motor, emotional, etc.). The assessment process is then carried out in formal, informal, and standardized ways.

The following are the most common methods of assessment:

*Interviews with Clients and/or Family Members
*Structured or Unstructured Observation
*Reviewing of Client Records
*Standardized Assessment Tests

Information gathered at the music therapy assessment is then used to determine if music therapy is indicated for the child. The therapist then formulates a music therapy treatment plan, which includes specific short-term objectives, long-term goals, and an expected timeline for therapy.

Music therapy interventions used with children can fall into two categories. The first, Supportive active therapy, is product- oriented and can included rhythm activities such as body percussion (stomping feet, clapping hands, etc.), singing songs which re-inforce nonmusical skills, awareness and expression, or movement to music (as simple as marching to the beat, as complex as structured dances). The second area is called Insight music therapy which is process-oriented. Activities could include song-writing, active listening and reacting, or auditory discrimination activities for sensory skill development. Music therapy for children is conducted either in a one-on-one session or in a group session. The therapist typically plays either a piano or a guitar, which allows for a wide variety of musical styles to suit the client’s preferences. The child is usually encouraged to play an instrument adapted to his or her unique abilities and needs. These elements are designed to improve the experience and outcome of the therapy.

DIFFERENT BENEFITS OF MUSIC THERAPY:

Prenatal music therapy:
Music Therapy can play an important role during pregnancy. At just 16 weeks, a fetus is able to hear their mother’s speech as well as singing. Through technologies, such as ultrasound, health care professionals are able to observe the movements of the unborn child responding to musical stimuli. Through these fetal observations, we see that the baby is capable of expressing its needs, preferences, and interests through movements in the womb. At the beginning of the second trimester, the ear structure is fully matured. By this time, the fetus will begin to hear not only maternal sounds, but also vibrations of instruments…..CLICK & SEE :

Prenatal music therapy has three main bennefits:

1.Prenatal Stress Relief: Pregnant women may experience high levels of stress which can negatively affect the baby. This will cause the body will release Norepinephrine and Cortisol hormones which will increase blood pressure and weaken the immune system of both mother and child. High levels of cortisol exposure in early development can increase the likelihood of the child later having anxiety, mental retardation, autism, and depression. Music therapists use music to elevate the stress threshold of an expectant mother which helps her to maintain a relaxed state during labour and birthing process. During a music therapy session, the mother is guided to listen to her internal rhythms, as well as listing to the movements and reactions of the fetus in response to her voice and music. This technique is useful in helping reduce the mother’s level of stress, and prepare her for the birth of her child.

2.Maternal-Fetal Bonding: Communication between the mother and fetus is essential during pregnancy. One way of strengthening the bond between the two is through music therapy. Music stimulation helps to develop the fetus’s nervous system, structurally and functionally. The unborn child especially prefers the voice of their mother. The most effective way to enhance communication is through singing. Lullabies are the most popular songs sung by mothers. Singing lullabies is a wonderful way for mothers to express their love and have the baby become familiarized with their mother’s melodies and intonations which will provide them a sense of security when they are born, because it will feel just like how they were in the womb. Electronic voice phenomena studies have shown that the father’s voice engages the fetus from feet to the abdomen – which will lead the baby to start walking at a younger age. The mother’s voice engages the fetus from waist to head which will strengthen the baby’s neck and upper limbs. Not only does prenatal singing benefit the fetus, it also help produce endorphins that automatically reduce the perception of pain and help relax breathing. A fetus can show preference for music; observations have shown the fetus’s movements are gentle when listening to soothing music, and comparatively, where there are dissonances included in the music, their movements are bigger and much more rhythmic, such as rolling. The fetus would be comforted by hearing slow-pace passages of Baroque music (Vivaldi and Handel) and lullabies sung by their mother.

3.Prenatal Language Development: Music is said to be the unborn child’s beginning of language learning. It can be consider as a pre-linguistic language that prepares the Auditory Sensory System to listen, combine, and produce language sounds. The fetus learns through the voice of their mother, not only from speech but songs. The sound is received by the baby through bone conduction when the mother speaks. The singing voice is said to have a wider range of frequencies than speech. Prenatal sounds are important during the prenatal period because it forms the basis of future learning and behaviour.

Music therapy for premature infants:
Music therapy has been shown to be very beneficial in stimulating growth and development in premature infants. Premature infants are those born at 37 weeks or less gestational stage. They are subject to numerous struggles, such as abnormal breathing patterns, decreased body fat and muscle tissue, as well as feeding issues. The coordination for sucking and breathing is often not fully developed, making feeding a challenge. The improved developmental activity and behavioural status of premature infants when they are discharged from the NICU, is directly related to the stimulation programs and interventions they benefited from during hospitalization, such as music therapy.

Music is typically conducted by a musical therapist in Neonatal Intensive Care (NICU), with five main techniques designed to benefit premature infants;

1.Live or Recorded Music: Live or recorded music has been effective in promoting respiratory regularity and oxygen saturation levels, as well as decreasing signs of neonatal distress. Since premature infants have sensitive and immature sensory modalities, music is often performed in a gentle and control environment, either in the form of audio recordings or live vocalization, although live singing has been shown to have a greater affect. Live music also reduces the physiological responses in parents. Studies have shown that by combining live music, such as harp music, with the Kangaroo Care, maternal anxiety is reduced. This allows for parents, especially mothers to spend important time bonding with their premature infants. Female singing voices are also more affective at soothing premature infants. Despite being born premature, infants show a preference for the sound of a female singing voice, making it more beneficial than instrumental music.

2.Promote Healthy Sucking Reflex: By using a Pacifier-Actived Lullaby Device, music therapists can help promote stronger sucking reflexes, while also reducing pain perception for the infant. The Gato Box is a small rectangular instrument that stimulates a prenatal heartbeat sound in a soft and rhythmic manner that has also been effective in aiding sucking behaviours.[41] The music therapist uses their fingers to tap on the drum, rather than using a mallet. The rhythm supports movement when feeding and promotes healthy sucking patterns. By increasing sucking patterns, babies are able to coordinate the important dual mechanisms of breathing, sucking and swallowing needed to feed, thus promoting growth and weight gain. When this treatment proves effective, infants are able to leave the hospital earlier.

3.Multimodal Stimulation and Music: By combining music, such as lullabies, and multimodal stimulation, premature infants were discharged from the NICU sooner, than those infants who did not receive therapy. Multimodal stimulation includes the applications of auditory, tactile, vestibular, and visual stimulation that helps aid in premature infant development. The combination of music and MMS helps premature infants sleep and conserve vital energy required to gain weight more rapidly. Studies have shown that girls respond more positively than boys during multimodal stimulation.[ While the voice is a popular choice for parents looking to bond with their premature infants, other effective instruments include the Remo Ocean Disk and the Gato Box. Both are used to stimulate the sounds of the womb. The Remo Ocean Disk, a round musical instrument that mimics the fluid sounds of the womb, has been shown to benefit decreased heart rate after therapeutic uses, as well as promoting healthy sleep patterns, lower respiratory rates and improve sucking behavior.

4.Infant Stimulation: This type of intervention uses musical stimulation to compensate for the lack of normal environmental sensory stimulation found in the NICU. The sound environment the NICU provides can be disruptive; however, music therapy can mask unwanted auditory stimuli and promote a calm environment that reduces the complications for high-risk or failure-to-thrive infants. Parent-infant bonding can also be affected by the noise of the NICU, which in turn can delay the interactions between parents and their premature infants. But music therapy creates a relaxed and peaceful environment for parents to speak and spend time with their babies while incubated.

5.Parent-Infant Bonding: Therapists work with parents so they may perform infant-directed singing techniques, as well as home care. Singing lullabies therapeutically can promote relaxation and decrease heart rate in premature infants. By calming premature babies, it allows for them to preserve their energy, which creates a stable environment for growth. Lullabies, such as “Twinkle Twinkle Little Star”, or other culturally relevant lullabies, have been shown to greatly soothe babies. These techniques can also improve overall sleep quality, caloric intake and feeding behaviours, which aids in development of the baby while they are still in the NICU. Singing has also shown greater results on oxygen saturation levels for infants while incubated, more than mothers speech alone. This technique promoted high levels of oxygen for longer periods of time.

Music therapy in child rehabilitation:
Music therapy has multiple benefits which contribute to the maintenance of health and the drive toward rehabilitation for children. Advanced technology that can monitor cortical activity offers a look at how music engages and produces changes in the brain during the perception and production of musical stimuli. Music therapy, when used with other rehabilitation methods, has increased the success rate of sensorimotor, cognitive, and communication rehabilitation. Music therapy intervention programs can include an average of 18 sessions of treatment. The achievement of a physical rehabilitation goal relies on the child’s existing motivation and feelings towards music and their commitment to engage in meaningful, rewarding efforts. Regaining full functioning also confides in the prognosis of recovery, the condition of the client, and the environmental resources available. Sessions may consist of either active techniques, where the client creates music, or receptive techniques, where the client listens to, analyze, move and respond to music. Both techniques use systematic processes where the therapists assist the client by using musical experiences and connections that collaborate as a dynamic force of change toward rehabilitation. The music is at times chosen by the client, or by the music therapist based on the clients reciprocation to the music.

Music has many calming and soothing properties that can be used as a sedative in rehabilitation. For example, a patient with chronic pain may decrease the physiological result of stress, and draw attention away from the pain by focusing on music. Music has the ability to associate physiological changes in the body and elicit physiological responses such as pulse rate, respiration rate, blood pressure, and muscle tension. Music may also stimulate a calming effect of the cardiovascular system.

Music therapy used in child rehabilitation has had a substantial emphasis on sensorimotor development including; balance and position, locomotion, agility, mobility, range of motion, strength, laterality and directionality. By using music during senorimotor rehabilitation, it allows clients to express themselves and motivates them to learn the active joint range of motion and motor coordination in which they are aiming to acquire. For example, clients with a brain injury may lack the ability to initiate movement. The intensely captivating and attention enhancing quality of music motivates clients to participate in physical activity or exercise by easing the discomfort and strenuousness of the physical rehabilitation and helps the client persevere without being conscious of the difficulty. Music can be an element of distraction, allowing the client to transcend into a positive, aesthetically-pleasing state that is beneficial to achieving their goals.[48] Research suggests a strong connection between motor activation and the cueing of musical rhythm. Rhythmic stimuli has been found to help balance training for those with a brain injury. Repetition of proficient rhythmic qualities will stimulate participants so that the abrasive beats will synchronize with neural activity during a rhythmic motor task. For example, clients with hemiplegia gain improvement of posture stability, and consistency of symmetrical strides and regularity in step lengths when listening to music with strong rhythmic beats.

Music therapy rehabilitation sessions that incorporate active techniques involve the client producing the music themselves. This may include the client making a musical composition, or performing by singing or chanting, playing instruments, or musically improvising. Singing is a form of rehabilitation for neurological impairments. Neurological impairments following a brain injury can be in the form of apraxia – loss to perform purposeful movements, dysarthria –muscle control disturbances due to damage of the central nervous system), aphasia (defect in expression causing distorted speech), or language comprehension. Singing training has been found to improve lung, speech clarity, and coordination of speech muscles, thus, accelerating rehabilitation of such neurological impairments. For example, melodic intonation therapy is the practice of communicating with others by singing to enhance speech or increase speech production by promoting socialization, and emotional expression.

When having the child actively participate with an instrument, it is especially important for the therapist to provide them with an instrument that they can readily and easily use. Clients with limited physical abilities may express frustration when they are not able to control their environment. The ability to employ and operate a musical instrument provides them a sense of relaxation and accomplishment. Instruments must be selected to provide immediately successful experiences. Certain adaptions of the instruments may be required in order for the people to manipulate them. For example, a drumstick’s handle should be manipulated to be more prominent for those clients that may have a weak grip. Electric music-making devices have been adapted to fit the clients limited but existing movements, strength, and abilities. Electronic devices, such as the Sound Beam and the Wave Rider- read a variety of small movements made by the clients and converts the movements into electronic musical information. The devices are programmed to create easy, yet pleasing notes and sounds in coordination to the participants’ movements. It is also crucial for the client to be aware that music making is simply a modality for rehabilitation and that their wellness is not dependent on their existing musical skills. It provides children with an outlet of expression that they may have lacked in the past or due to present circumstances. By accomplishing the production of musical sounds despite their weaknesses and disabilities, it encourages the client and relieves their anxiety that they may acquire at the thought of playing musical instrument without experience. By using such adaptive music devices, it grants client’s the ability to create sounds that are originally expressive and allows them to experience affirmation –a feeling of capability to control ones own environment- an ability they may not be familiar with.

Music therapy and children with autism:
Music therapy can be a particularly useful when working with children with autism due to the nonverbal, non-threatening nature of the medium.[51] Studies have shown that children with autism have difficulty with joint attention, symbolic communication and sharing of positive affect. Use of music therapy has demonstrated improvements of socially acceptable behaviors. Wan, Demaine, Zipse, Norton, & Schlaug (2010) found singing and music making may engage areas of the brain related to language abilities, and that music facilitated the language, social, and motor skills.   Successful therapy involves long-term individual intervention tailored to each child’s needs. Passing and sharing instruments, music and movement games, learning to listen and singing greetings and improvised stories are just a few ways music therapy can improve a child’s social interaction. For example passing a ball back and forth to percussive music or playing sticks and cymbals with another person might help foster the child’s ability to follow directions when passing the ball and learn to share the cymbals and sticks. In addition to improved social behaviors music therapy has been shown to also increase communication attempts, increase focus and attention, reduce anxiety, and improve body awareness and coordination.

Since up to 30 per cent of children with autism are nonverbal and many have difficulty understanding verbal commands music therapy becomes very useful as it has been found that music can improve the mapping of sounds to actions. So by pairing music with actions, and with many hours of training the neural pathways for speech can be improved. Child-appropriate action songs would be like playing the game “peek-ka-boo” or “eeny meeny miney mo” with a musical accompaniment, usually a piano or guitar.

Children with autism are also prone to more bouts of anxiety than the average child. Short sessions (15 – 20 mins) of listening to percussive music or classical music with a steady rhythm have been shown to alleviate symptoms of anxiety and temporarily decrease anxiety-related behaviour. Music with a steady 4/4 beat is thought to work best due to the predictability of the beat.

Target behaviours such as restlessness, aggression and noisiness can also be affected by the use of music therapy. Weekly sessions ranging for ½ hour to 1 hour during which a therapist plays child-preferred melodies such as Twinkle Twinkle Little Star and engages the child in quiet singing increases socially acceptable behaviour such as using an appropriate volume when speaking. Studies also suggest that playing one of the child’s favorite songs while the child and therapist both play the piano or strum chords on a guitar can increase a child’s ability to hold eye contact and share in an experience due to their enjoyment of the therapy.

Musical improvisation during a one on one session has also been shown to be highly effective with increasing joint attention. Some noted improvisation techniques are using a welcome song that includes the child’s name, which allows the child to get used to their surroundings; an adult-led song followed by a child led song and then conclude with a goodbye song. During such sessions the child would most likely sit across from the therapist on the floor or beside the therapist on the piano bench. Composing original music that incorporates the child’s day-to-day life with actions and words is also a part of improvisation. The shared music making experience allows for spontaneous interpersonal responses from the child and may motivate the child to increase positive social behaviour and initiate further interaction with the therapist.

Some common instruments in music therapy for children are:

Upright piano, Guitar, Xylophone, Small guiro, Paddle drums, Egg shakers, Finger cymbals, Birdcalls, Whistles, & Toy hand bells.
Music therapy has also been recognized as a method for children with autism. Music therapy helps stabilize moods, increase frustration tolerance, identify a range of emotions, and improve self-expression along with much more. The visual and auditory sensory system is responsible for interpreting sounds and images. With autistic children, if a sound or image is unpleasant the child may not have the ability to express itself, which makes it difficult for a therapist, parent, etc. to interpret. Music engages the brain in both sub-coritcal and neo-cortical levels, which means it is not critical to ‘think’ while listening to music when hearing the notes and sounds. Music therapy, in the topic of austism’s sensory interpretation, provides repetitive stimuli which aim to “teach” the brain other possible ways to respond that might be more useful as they grow olde.
Music therapy for Adolescents:

Mood disorders:
According to the Mayo Health Clinic, two to three thousand out of every 100,000 adolescents will have mood disorders, and out of those two to three thousand, eight to ten will commit suicide. Two prevalent mood disorders in the adolescent population are clinical depression and bipolar disorder.

On average, American adolescents listen to approximately 4.5 hours of music per day and are responsible for 70% of pop music sales. Now, with the invention of new technologies such as the iPod and digital downloads, access to music has become easier than ever. As children make the transition into adolescence they become less likely to sit and watch TV, an activity associated with family, and spend more of their leisure time listening to music, an activity associated with friends.

Adolescents obtain many benefits from listening to music, including emotional, social, and daily life benefits, along with help in forming their identity. Music can provide a sense of independence and individuality, which in turn contributes to an adolescent’s self-discovery and sense of identity. Music also offers adolescents relatable messages that allow them to take comfort in knowing that others feel the same way they do. It can also serve as a creative outlet to release or control emotions and find ways of coping with difficult situations. Music can improve an adolescent’s mood by reducing stress and lowering anxiety levels, which can help counteract or prevent depression. Music education programs provide adolescents with a safe place to express themselves and learn life skills such as self-discipline, diligence, and patience. These programs also promote confidence and self-esteem. Ethnomusicologist Alan Merriam (1964) once stated that music is a universal behavior – it is something with which everyone can identify. Among adolescents, music is a unifying force, bringing people of different backgrounds, age groups, and social groups together.

Referrals and assessments;
While many adolescents may listen to music for its therapeutic qualities, it does not mean every adolescent needs music therapy. Many adolescents go through a period of teenage angst characterized by intense feelings of strife that are caused by the development of their brains and bodies. Some adolescents develop more serious mood disorders such as major clinical depression and bipolar disorder. Adolescents diagnosed with a mood disorder may be referred to a music therapist by a physician, therapist, or school counselor/teacher. When a music therapist gets a referral, he or she must first assess the patient and then create goals and objectives before beginning the actual therapy. According to the American Music Therapy Association Standards of Clinical Practice assessments should include the “general categories of psychological, cognitive, communicative, social, and physiological functioning focusing on the client’s needs and strengths…and will also determine the client’s response to music, music skills, and musical preferences” The result of the assessment is used to create an individualized music therapy intervention plan.

Treatment techniques:
There are many different music therapy techniques used with adolescents. The music therapy model is based on various theoretical backgrounds such as psychodynamic, behavioral, and humanistic approaches. Techniques can be classified as active vs. receptive and improvisational vs. structured.  The most common techniques in use with adolescents are musical improvisation, the use of precomposed songs or music, receptive listening to music, verbal discussion about the music, and incorporating creative media outlets into the therapy. Research also showed that improvisation and the use of other media were the two techniques most often used by the music therapists. The overall research showed that adolescents in music therapy “change more when discipline-specific music therapy techniques, such as improvisation and verbal reflection of the music, are used.” The results of this study showed that music therapists should put careful thought into their choice of technique with each individual client. In the end, those choices can affect the outcome of the treatment.

To those unfamiliar with music therapy the idea may seem a little strange, but music therapy has been found to be as effective as traditional forms of therapy. In a meta-analysis of the effects of music therapy for children and adolescents with psychopathology, Gold, Voracek, and Wigram (2004) looked at ten studies conducted between 1970 and 1998 to examine the overall efficacy of music therapy on children and adolescents with behavioral, emotional, and developmental disorders. The results of the meta-analysis found that “music therapy with these clients has a highly significant, medium to large effect on clinically relevant outcomes.” More specifically, music therapy was most effective on subjects with mixed diagnoses. Another important result was that “the effects of music therapy are more enduring when more sessions are provided.”

One example of clinical work is that done by music therapists who work with adolescents to increase their emotional and cognitive stability, identify factors contributing to distress and initiate changes to alleviate that distress. Music therapy may also focus on improving quality of life and building self-esteem, a sense self-worth, and confidence. Improvements in these areas can be measured by a number of tests, including qualitative questionnaires like Beck’s Depression Inventory, State and Trait Anxiety Inventory, and Relationship Change Scale.[65] Effects of music therapy can also be observed in the patient’s demeanor, body language, and changes in awareness of mood.

Two main methods for music therapy are group meetings and one-one sessions. Group music therapy can include group discussions concerning moods and emotions in or toward music, songwriting, and musical improvisation. Groups emphasizing mood recognition and awareness, group cohesion, and improvement in self-esteem can be effective in working with adolescents. Group therapy, however, is not always the best choice for the client. Ongoing one-on-one music therapy has also been shown to be effective. One-on-one music therapy provides a non-invasive, non-judgmental environment, encouraging clients to show capacities that may be hidden in group situations.

Music Therapy in which clients play musical instruments directly, show very promising results. Specifically, playing wind instruments strengthens oral and respiratory muscles, sound vocalization, articulation, and improves breath support.[68] Symbolic Communication Training Through Musicis also an important technique in playing instruments in music therapy, because this makes communication (verbally and non verbally) improved in social situations. Most importantly, is that music provides a time cue for the body to remain regulated. Making music is also important for people of all ages because it causes motivation, increases “psychomotor” activity, causes an individual to identify with a group (in group music), regulates breathing, improves organizational skills, and increases coordination.

Though more research needs to be done to ascertain the effect of music therapy on adolescents with mood disorders, most research has shown positive effects.
Music therapy for Medical disorders:

Heart disease:
According to a 2009 Cochrane review some music may reduce heart rate, respiratory rate, and blood pressure in those with coronary heart disease.   Music does not appear to have much effect on psychological distress. “The quality of the evidence is not strong and the clinical significance unclear”.

Neurological disorders:
The use of music therapy in treating mental and neurological disorders is on the rise. Music therapy has showed effectiveness in treating symptoms of many disorders, including schizophrenia, amnesia, dementia and Alzheimer’s, Parkinson’s disease, mood disorders such as depression, aphasia and similar speech disorders, and Tourette’s syndrome, among others.

While music therapy has been used for many years, up until the mid-1980s little empirical research had been done to support the efficacy of the treatment. Since then, more research has focused on determining both the effectiveness and the underlying physiological mechanisms leading to symptom improvement. For example, one meta-study covering 177 patients (over 9 studies) showed a significant effect on many negative symptoms of psychopathologies, particularly in developmental and behavioral disorders. Music therapy was especially effective in improving focus and attention, and in decreasing negative symptoms like anxiety and isolation.

The following sections will discuss the uses and effectiveness of music therapy in the treatment of specific pathologies.

Stroke:…click & see
Music has been shown to affect portions of the brain. One reason for the effectiveness of music therapy for stroke victims is the capacity of music to affect emotions and social interactions. Research by Nayak et al. showed that music therapy is associated with a decrease in depression, improved mood, and a reduction in state anxiety. Both descriptive and experimental studies have documented effects of music on quality of life, involvement with the environment, expression of feelings, awareness and responsiveness, positive associations, and socialization. Additionally, Nayak et al. found that music therapy had a positive effect on social and behavioral outcomes and showed some encouraging trends with respect to mood.

More recent research suggests that music can increase a patient’s motivation and positive emotions. Current research also suggests that when music therapy is used in conjunction with traditional therapy it improves success rates significantly. Therefore, it is hypothesized that music therapy helps a victim of stroke recover faster and with more success by increasing the patient’s positive emotions and motivation, allowing him or her to be more successful and feel more driven to participate in traditional therapies.

Recent studies have examined the effect of music therapy on stroke patients when combined with traditional therapy. One study found the incorporation of music with therapeutic upper extremity exercises gave patients more positive emotional effects than exercise alone. In another study, Nayak et al. found that rehabilitation staff rated participants in the music therapy group more actively involved and cooperative in therapy than those in the control group. Their findings gave preliminary support to the efficacy of music therapy as a complementary therapy for social functioning and participation in rehabilitation with a trend toward improvement in mood during acute rehabilitation.

Current research shows that when music therapy is used in conjunction with traditional therapy, it improves rates of recovery and emotional and social deficits resulting from stroke. A study by Jeong & Kim examined the impact of music therapy when combined with traditional stroke therapy in a community-based rehabilitation program. Thirty-three stroke survivors were randomized into one of two groups: the experimental group, which combined rhythmic music and specialized rehabilitation movement for eight weeks; and a control group that sought and received traditional therapy. The results of this study showed that participants in the experimental group gained not only more flexibility and wider range of motion, but an increased frequency and quality of social interactions and positive mood.

Music has proven useful in the recovery of motor skills. Rhythmical auditory stimulation in a musical context in combination with traditional gait therapy improved the ability of stroke patients to walk. The study consisted of two treatment conditions, one which received traditional gait therapy and another which received the gait therapy in combination with the rhythmical auditory stimulation. During the rhythmical auditory stimulation, stimulation was played back measure by measure, and was initiated by the patient’s heel-strikes. Each condition received fifteen sessions of therapy. The results revealed that the rhythmical auditory stimulation group showed more improvement in stride length, symmetry deviation, walking speed and rollover path length (all indicators for improved walking gait) than the group that received traditional therapy alone.

Schneider et al. also studied the effects of combining music therapy with standard motor rehabilitation methods.[80] In this experiment, researchers recruited stroke patients without prior musical experience and trained half of them in an intensive step by step training program that occurred fifteen times over three weeks, in addition to traditional treatment. These participants were trained to use both fine and gross motor movements by learning how to use the piano and drums. The other half of the patients received only traditional treatment over the course of the three weeks. Three-dimensional movement analysis and clinical motor tests showed participants who received the additional music therapy had significantly better speed, precision, and smoothness of movement as compared to the control subjects. Participants who received music therapy also showed a significant improvement in every-day motor activities as compared to the control group.[80] Wilson, Parsons, & Reutens looked at the effect of melodic intonation therapy (MIT) on speech production in a male singer with severe Broca’s aphasia.[82] In this study, thirty novel phrases were taught in three conditions: unrehearsed, rehearsed verbal production (repetition), or rehearsed verbal production with melody (MIT). Results showed that phrases taught in the MIT condition had superior production, and that compared to rehearsal, effects of MIT lasted longer.

Another study examined the incorporation of music with therapeutic upper extremity exercises on pain perception in stroke victims. Over the course of eight weeks, stroke victims participated in upper extremity exercises (of the hand, wrist, and shoulder joints) in conjunction with one of the three conditions: song, karaoke accompaniment, and no music. Patients participated in each condition once, according to a randomized order, and rated their perceived pain immediately after the session. Results showed that although there was no significant difference in pain rating across the conditions, video observations revealed more positive affect and verbal responses while performing upper extremity exercises with both music and karaoke accompaniment. Nayak et al. examined the combination of music therapy with traditional stroke rehabilitation and also found that the addition of music therapy improved mood and social interaction. Participants who had suffered traumatic brain injury or stroke were placed in one of two conditions: standard rehabilitation or standard rehabilitation along with music therapy. Participants received three treatments per week for up to ten treatments. Therapists found that participants who received music therapy in conjunction with traditional methods had improved social interaction and mood.

Dementia:...click & see
Alzheimer’s disease and other types of dementia are among the disorders most commonly treated with music therapy. Like many of the other disorders mentioned, some of the most common significant effects are seen in social behaviors, leading to improvements in interaction, conversation, and other such skills. A meta-study of over 330 subjects showed music therapy produces highly significant improvements to social behaviors, overt behaviors like wandering and restlessness, reductions in agitated behaviors, and improvements to cognitive defects, measured with reality orientation and face recognition tests. As with many studies of MT’s effectiveness, these positive effects on Alzheimer’s and other dementias are not homogeneous among all studies. The effectiveness of the treatment seems to be strongly dependent on the patient, the quality and length of treatment, and other similar factors.

Another meta-study examined the proposed neurological mechanisms behind music therapy’s effects on these patients. Many authors suspect that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. Others suggest that music serves as a sort of mediator for social interactions, providing a vessel through which to interact with others without requiring much cognitive load.

Amnesia:….click & see
Some symptoms of amnesia have been shown to be alleviated through various interactions with music, including playing and listening. One such case is that of Clive Wearing, whose severe retrograde and anterograde amnesia have been detailed in the documentaries Prisoner of Consciousness and The Man with the 7 Second Memory. Though unable to recall past memories or form new ones, Wearing is still able to play, conduct, and sing along with music learned prior to the onset of his amnesia, and even add improvisations and flourishes.

Wearing’s case reinforces the theory that episodic memory fundamentally differs from procedural or semantic memory. Sacks suggests that while Wearing is completely unable to recall events or episodes, musical performance (and the muscle memory involved) are a form of procedural memory that is not typically hindered in amnesia cases [Sacks]. Indeed, there is evidence that while episodic memory is reliant on the hippocampal formation, amnesiacs with damage to this area can show a loss of episodic memory accompanied by (partially) intact semantic memory.

Aphasia:….click & see
Melodic intonation therapy (MIT) is a commonly used method of treating aphasias, particularly those involving speech deficits (as opposed to reading or writing). MIT is a multi-stage treatment that involves committing words and speech rhythm to memory by incorporating them into song. The musical and rhythmic aspects are then separated from the speech and phased out, until the patient can speak normally. This method has slight variations between adult patients and child patients, but both follow the same basic structure.

While MIT is a commonly used therapy, research supporting its effectiveness is lacking. Some recent research suggests that the therapy’s efficacy may stem more from the rhythmic components of the treatment rather than the melodic aspects.
Music Therapy for Psychiatric disorders:

Schizophrenia:…click & see
Music therapy is used with schizophrenic patients to ameliorate many of the symptoms of the disorder. Individual studies of patients undergoing music therapy showed diminished negative symptoms such as flattened affect, speech issues, and anhedonia and improved social symptoms such as increased conversation ability, reduced social isolation, and increased interest in external events.

Meta-studies have confirmed many of these results, showing that music therapy in conjunction with standard care to be superior to standard care alone. Improvements were seen in negative symptoms, general mental state, depression, anxiety, and even cognitive functioning. These meta-studies have also shown, however, that these results can be inconsistent and that they depend heavily on both the quality and number of therapy sessions.

Depression:...click & see
Music therapy has been found to have numerous significant outcomes for patients with major depressive disorder. A systematic review of five randomized trials found that people with depression generally accepted music therapy and was found to produce improvements in mood when compared to standard therapy. Another study showed that MDD patients were better able to express their emotional states while listening to sad music than while listening to no music or to happy, angry, or scary music. The authors found that this therapy helped patients overcome verbal barriers to expressing emotion, which can assist therapists in successfully guiding treatment.

Other studies have provided insight into the physiological interactions between music therapy and depression. Music has been shown to decrease significantly the levels of the stress hormone cortisol, leading to improved affect, mood and cognitive functioning. A study also found that music led to a shift in frontal lobe activity (as measured by EEG) in depressed adolescents. Music was shown to shift activity from the right frontal lobe to the left, a phenomenon associated with positive affect and mood.
Use of Music Therapy Region wise:

Africa:
Research has shown that in many parts of Africa during male and female circumcision, bone setting, or traditional surgery and bloodletting, lyrical music related to endurance has been used to reduce anticipated pain, therapeutically. In 1999, the first program for music therapy in Africa opened in Pretoria, South Africa. Research has shown that in Tanzania patients can receive palliative care for life-threatening illnesses directly after the diagnosis of these illnesses. This is different from many Western countries, because they reserve palliative care for patients who have an incurable illness. Music is also viewed differently between Africa and Western countries. In Western countries and a majority of other countries throughout the world, music is traditionally seen as entertainment whereas in many African cultures, music is used in recounting stories, celebrating life events, or sending messages

Australia:
In Australia in 1949, music therapy (not clinical music therapy as understood today) was started through concerts organized by the Australian Red Cross along with a Red Cross Music Therapy Committee. The key Australian body, AMTA, the Australian Music Therapy Association, was founded in 1975.

Norway:
Norway is widely recognised as an important country for music therapy research. Its two major research centres are the Center for Music and Health[94] with the Norwegian Academy of Music in Oslo, and the Grieg Academy Centre for Music Therapy (GAMUT),[95] at University of Bergen. The former was mostly developed by professor Even Ruud, while professor Brynjulf Stige is largely responsible for cultivating the latter. The centre in Bergen includes 3 professors and 2 associate professors, as well as lecturers and PhD students. The centre in Bergen has 18 staff, including 2 professors and 4 associate professors, as well as lecturers and PhD students. Two of the field’s major international research journals are based in Bergen: Nordic Journal for Music Therapy and Voices: A World Forum for Music Therapy. Norway’s main contribution to the field is mostly in the area of “community music therapy”, which tends to be as much oriented toward social work as individual psychotherapy, and music therapy research from this country uses a wide variety of methods to examine diverse methods in across an array of social contexts, including community centres, medical clinics, retirement homes, and prisons.
United States:
Music therapy has existed in its current form in the United States since 1944 when the first undergraduate degree program in the world was begun at Michigan State University and the first graduate degree program was established at the University of Kansas. The American Music Therapy Association (AMTA) was founded in 1998 as a merger between the National Association for Music Therapy (NAMT, founded in 1950) and the American Association for Music Therapy (AAMT, founded in 1971). Numerous other national organizations exist, such as the Institute for Music and Neurologic Function, Nordoff-Robbins Center For Music Therapy, and the Association for Music and Imagery. Music therapists use ideas from different disciplines such as speech and language, physical therapy, medicine, nursing, and education.

A music therapy degree candidate can earn an undergraduate, master’s or doctoral degree in music therapy. Many AMTA approved programs offer equivalency and certificate degrees in music therapy for students that have completed a degree in a related field. Some practicing music therapists have held PhDs in fields other than, but usually related to, music therapy. Recently, Temple University established a PhD program in music therapy. A music therapist typically incorporates music therapy techniques with broader clinical practices such as psychotherapy, rehabilitation, and other practices depending on client needs. Music therapy services rendered within the context of a social service, educational, or health care agency are often reimbursable by insurance and sources of funding for individuals with certain needs. Music therapy services have been identified as reimbursable under Medicaid, Medicare, private insurance plans and federal and state government programs.

A degree in music therapy requires proficiency in guitar, piano, voice, music theory, music history, reading music, improvisation, as well as varying levels of skill in assessment, documentation, and other counseling and health care skills depending on the focus of the particular university’s program. A music therapist may hold the designations CMT (Certified Music Therapist), ACMT (Advanced Certified Music Therapist), or RMT (Registered Music Therapist) – credentials previously conferred by the former national organizations AAMT and NAMT ; these credentials remain in force through 2020 and have not been available since 1998. The current credential available is MT-BC. To become board certified, a music therapist must complete a music therapy degree from an accredited AMTA program at a college or university, successfully complete a music therapy internship, and pass the Board Certification Examination in Music Therapy, administered through The Certification Board for Music Therapists. To maintain the credential, either 100 units of continuing education must be completed every five years, or the board exam must be retaken near the end of the five-year cycle. The units claimed for credit fall under the purview of The Certification Board for Music Therapists. North Dakota, Nevada and Georgia have established licenses for music therapists. In the State of New York, the License for Creative Arts Therapies (LCAT) incorporates the music therapy credentials within their licensure.

United Kingdom:
Live music was used in hospitals after both World Wars as part of the treatment program for recovering soldiers. Clinical music therapy in Britain as it is understood today was pioneered in the 1960s and 1970s by French cellist Juliette Alvin whose influence on the current generation of British music therapy lecturers remains strong. Mary Priestley, one of Juliette Alvin’s students, created “analytical music therapy”. The Nordoff-Robbins approach to music therapy developed from the work of Paul Nordoff and Clive Robbins in the 1950/60s.

Practitioners are registered with the Health Professions Council and, starting from 2007, new registrants must normally hold a master’s degree in music therapy. There are master’s level programs in music therapy in Manchester, Bristol, Cambridge, South Wales, Edinburgh and London, and there are therapists throughout the UK. The professional body in the UK is the British Association for Music Therapy[98] In 2002, the World Congress of Music Therapy, coordinated and promoted by the World Federation of Music Therapy, was held in Oxford on the theme of Dialogue and Debate.[99] In November 2006, Dr. Michael J. Crawford and his colleagues again found that music therapy helped the outcomes of schizophrenic patients.

India:
The roots of musical therapy in India, can be traced back to ancient Hindu mythology, Vedic texts, and local folk traditions. It is very possible that music therapy has been used for hundreds of years in the Indian culture.

Suvarna Nalapat has studied music therapy in the Indian context. Her books Nadalayasindhu-Ragachikilsamrutam (2008), Music Therapy in Management Education and Administration (2008) and Ragachikitsa (2008) are accepted textbooks on music therapy and Indian arts.

The “Music Therapy Trust of India” is yet another venture in the country. It was started by Margaret Lobo.
Source: http://en.wikipedia.org/wiki/Music_therapy

Hope Therapy

Hope is an emotion characterized by positive feelings about the immediate or long-term future and often coupled with high motivation, optimism, and a generally elevated mood.Hope is a partially subjective term, and both psychologists and philosophers have struggled to define it. Some argue that hopefulness is a relatively stable personality trait, others believe that hope depends on external circumstances and previous experience, and some people view hope as a choice. Hope is commonly associated with warm feelings about the future, an increased willingness to work toward a goal, and an upbeat mood.

Hope therapy is a fairly recent idea with a fairly basic point. The main way this therapy is practiced is by teaching people in a group class setting to become more oriented toward positive thinking . Positive thinking with positive goals and behavior will help people toachieve their goals. It is separate from the idea of optimism, which is generally having a pervasive belief that good things are likely to happen. Instead, researchers believe that people can be taught to improve their outlook and minor depression in class settings, instead of through traditional talk therapy, which may tend to focus on negative experiences.

CLICK & SEE
It is observed that Hope therapy helps a lot to the people with severe macular degeneration, and people with mild depression, who were not classed as having a mental illness. Most people learn how to create goals, how to determine ways to reach goals and also how to use positive self-talk. Instead of focusing on negative incidents. Hope therapy relied on positive goal-based training. Many people in the groups noted significant elevation of mood, were able to absorb the training and became more goal oriented and were successfully able to use positive self-talk to diminish negative thinking patterns.

Hope therapy is  not just about the “power of positive thinking.” Instead it is based somewhat on the cognitive behavioral model of therapy which works to replace old or negative “hot thoughts” or core beliefs with new ones that are more truthful and positive. However, cognitive behavioral therapy (CBT) does spend at least some time analyzing how negative thoughts or experiences have influenced thoughts and behavior patterns in the here and now. Hope therapy appears to differ from this by focusing more on simply learning to change mindset, without much examination of what caused negative mindset in the past.

People who are facing personal and emotional conflicts, it is not that everything is lost for them. There is HOPE for them, they can also leave beautiful and happy life if some goal is set for them and with proper mental training they start exerting to reach the goal. The Hope Therapy Center (HTC) is a place where disheartened people may find healing and an opportunity to talk with a trained pastoral psychotherapist.

Hopelessness can also affect physical health. People who are not optimistic about their health or about their medical treatment are more likely to remain sick, more likely to report high levels of pain, and less likely to see an improvement in their overall health. Some mental health practitioners, aware of the role hope plays, encourage clients to work on thinking positively about life developments and finding things to be hopeful about. Many mental health professionals believe that hope is an indispensable key to happiness and that people cannot be happy without hope.

Hope therapy will be very much active and successful if this therapy is done along with Yoga exercise with Pranayama & Meditation under the guide line of some expert.

Help taken from:
http://www.wisegeek.com/what-is-hope-therapy.htm
http://www.hopetherapycenter.com/index.html
http://www.goodtherapy.org/blog/psychpedia/what-is-hope