Dentistry

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1 During a dental visit, relaxing music leads to increases of .... speed, stride length and gait symmetry and arm .... withdrawal from daily life and improve cognitive ...

The impact of the arts in

Dentistry - the evidence

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During a dental visit, relaxing music leads to increases of up to 32% of adults reporting low rather than high tension and 38% reportedly adjusting well to their dental treatment.1

32% 38% low tension adjusting well 2

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Ten-minute cartoon animations on dental care can improve dental health awareness in primary school children by up to 52% and reduce plaque by up to 19%.4

-19% plaque

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Lavender smells can reduce anxiety in patients in a dental waiting room and orange smells can increase happiness.8, 9

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Films shown through headsets can reduce physical distress during dental injections by up to 28% in children.10

Relaxing music during dental treatment significantly decreases stress hormones such as ACTH and increases the immune optimising protein sIgA.2, 3

+52% awareness

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Immersive relaxation films can cut pain by over 80% during treatment in adults with periodontitis.7

A singing tooth brush has been shown to improve oral health in blind children.5

An audio-pillow playing music with guided imagery during dental implant surgery can reduce blood pressure and treat fear.6

-80% pain in adults

-28% physical distress 9

Video eye-glasses during dental examinations lead to excellent, very good or good behaviour in 95% of children.10

95% good behaviour 10

Pythagoras' Golden Proportion found in art and nature applied to the dimensions of a central incisor determines the most aesthetic result.11

References 1. Olszewska, I. & Zarow, M. Does music during dental treatment make a difference? J Dent Res 82, (2003). 2. Goff, L. C., Rebollo Pratt, R. & Madriga, J. L. Music listening and S-IgA levels in patients undergoing a dental procedure. Int. J. Arts Med. 5, 22–26 (1997). 3. Oyama, T. et al. Musik in der Medizin / Music in Medicine (eds. Spintge, D. med R. & Droh, D. med R.) 223–226 (Springer Berlin Heidelberg, 1987). at 4. Ness, A. The Effects of the Preventive Dentistry Audio-Visual Instructional Program on the Knowledge, Attitude and behavior of Elementary School Aged Children in Romania. (University of Wisconsin-Stout, 2010). 5. Shetty, V., Hegde, A., Varghese, E. & Shetty, V. A Novel Music based Tooth Brushing System for Blind Children. J. Clin. Pediatr. Dent. 37, 251–256 (2013). 6. Eitner, S., Sokol, B., Wichmann, M., Bauer, J. & Engels, D. Clinical Use of a Novel Audio Pillow With Recorded Hypnotherapy Instructions and Music for Anxiolysis During Dental Implant Surgery: A Prospective Study. Int. J. Clin. Exp. Hypn. 59, 180–197 (2011). 7. Hoffman, H. G. et al. The Effectiveness of Virtual Reality for Dental Pain Control: A Case Study. Cyberpsychol. Behav. 4, 527–535 (2001). 8. Lehrner, J., Marwinski, G., Lehr, S., Johren, P. & Deecke, L. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiol. Behav. 86, 92–95 (2005). 9. Kritsidima, M., Newton, T. & Asimakopoulou, K. The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial. Community Dent. Oral Epidemiol. 38, 83–87 (2010). 10. Ram, D. et al. Audiovisual video eyeglass distraction during dental treatment in children. Quintessence Int. Berl. Ger. 1985 41, 673–679 (2010). 11. Ahmad, I. Geometric considerations in anterior dental aesthetics: restorative principles. Pract. Periodontics Aesthetic Dent. PPAD 10, 813–822; quiz 824 (1998).

The impact of the arts in

Psychiatry, Psychology & Neuroscience - the evidence

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2 3

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Listening to music after a stroke can induce long-term plastic changes in early sensory processing, better cortical connectivity and enhanced cognitive recovery.1–3

Drama therapy for sexually abused teenagers can reduce hostility, depression and psychotic thinking.4

Magic tricks for children with hemiplegia can improve speed and performance of the affected hand and lead to an almost four-fold increase in use.5

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Music-based movement therapy can improve walking speed, stride length and gait symmetry and arm extension in patients with acquired brain injury.8

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Museum object handling and art viewing can improve wellbeing, confidence and optimism in dementia patients and caregivers.9

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Diaries written by staff and families for patients in intensive care can reduce post-traumatic stress-related symptoms.10, 11

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The use of arts therapies in forensic psychiatry can reduce destructive aggression and promote self-expression, self-control and empathy.12

For patients with dementia, background music can lead to more specific and emotional memories, faster memory recall and enhanced mood.6

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Arts- and design-enhanced A&E departments can lead to a 50% reduction in threatening body language and aggressive behaviour from patients.13

-50% 5

Group drumming can reduce anxiety, depression and inflammatory immune response in mental health service users.7

aggressive behaviour

References 1. Särkämö, T. et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain 131, 866–876 (2008). 2. Särkämö, T. et al. Music and Speech Listening Enhance the Recovery of Early Sensory Processing after Stroke. J. Cogn. Neurosci. 22, 2716–2727 (2009). 3. Altenmüller, E., Marco-Pallares, J., Münte, T. F. & Schneider, S. Neural Reorganization Underlies Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy. Ann. N. Y. Acad. Sci. 1169, 395–405 (2009). 4. Mackay, B., Gold, M. & Gold, E. A pilot study in drama therapy with adolescent girls who have been sexually abused. Arts Psychother. 14, 77–84 (1987). 5. Green, D. et al. A multi-site study of functional outcomes following a themed approach to hand-arm bimanual intensive therapy for children with hemiplegia. Dev. Med. Child Neurol. 55, 527–533 (2013). 6. El Haj, M., Fasotti, L. & Allain, P. The involuntary nature of music-evoked autobiographical memories in Alzheimer’s disease. Conscious. Cogn. 21, 238–246 (2012). 7. Fancourt, D. et al. Group drumming modulates cytokine activity in mental health service users: a preliminary study. Psychother. Psychosom. (In press). 8. Bradt, J., Magee, W. L., Dileo, C., Wheeler, B. L. & McGilloway, E. Cochrane Database of Systematic Reviews ( John Wiley & Sons, Ltd, 2010). at 9. Johnson, J., Culverwell, A., Hulbert, S., Robertson, M. & Camic, P. M. Museum activities in dementia care: Using visual analog scales to measure subjective wellbeing. Dement. Lond. Engl. (2015). doi:10.1177/1471301215611763 10. Garrouste-Orgeas, M. et al. Impact of an intensive care unit diary on psychological distress in patients and relatives*: Crit. Care Med. 40, 2033–2040 (2012). 11. Jones, C., Backman, C. & Griffiths, R. D. Intensive Care Diaries and Relatives’ Symptoms of Posttraumatic Stress Disorder After Critical Illness: A Pilot Study. Am. J. Crit. Care 21, 172–176 (2012). 12. Smeijsters, H. & Cleven, G. The treatment of aggression using arts therapies in forensic psychiatry: Results of a qualitative inquiry. Arts Psychother. 33, 37–58 (2006). 13. Design Council. Reducing violence and aggression in A&E: Through a better experience. (Design Council, 2013). at

The impact of the arts in

Nursing & Midwifery - the evidence

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Playing lullabies to premature infants can stabilise physiologic measures, increase oxygen saturation, increase their weight and shorten their hospital stay.1–5

-55% adult falls 7

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Mothers who sing to their babies enhance mother-infant bonding and increase their baby’s feeding ability.6-8

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Babies can recognise sounds heard as early as 20 weeks into pregnancy and remember them as much as one year after birth.9, 10

20 WEEKS 4

Background music can decrease aggressive agitation in dementia patients during bathing by 80% and during mealtimes by 60%.16-18

-80% -60% bathing mealtimes 1 YEAR

Creative arts therapy can provide social support and increased self-esteem and confidence in mothers with postnatal depression.11

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Reminiscence workshops can reduce withdrawal from daily life and improve cognitive function in patients with Alzheimer’s disease.19, 20

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Storytelling can help families to make sense of illness and death in palliative care and bereavement.21-23

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Dance and movement workshops can improve gait and lead to a reduction of 55% in falls in older adults.13-15

Art therapy can improve collaborative behaviour and coping in children in hospital undergoing painful procedures.12

Art therapy can reduce stress and burn-out amongst nurses, help the processing of grief and build team morale.24, 25

References 1. Standley, J. M. & Moore, R. S. Therapeutic effects of music and mother’s voice on premature infants. Pediatr. Nurs. 21, 509–512, 574 (1995). 2. Cassidy, J. W. & Standley, J. M. The Effect of Music Listening on Physiological Responses of Premature Infants in the NICU. J. Music Ther. 32, 208–227 (1995). 3. Lorch, C. A., Lorch, V., Diefendorf, A. O. & Earl, P. W. Effect of Stimulative and Sedative Music on Systolic Blood Pressure, Heart Rate, and Respiratory Rate in Premature Infants. J. Music Ther. 31, 105–118 (1994). 4. Caine, J. The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates in a newborn intensive care unit. J Music Ther 28, 180–92 (1991). 5. Chapman, J. S. The relation between auditory stimulation of short gestation infants and their gross motor limb activity. (1975). at 6. Standley, J. M. The effect of music-reinforced nonnutritive sucking on feeding rate of premature infants. J. Pediatr. Nurs. 18, 169–173 (2003). 7. Standley, J. M. The Role of Music in Pacification/Stimulation of Premature Infants with Low Birthweights. Music Ther. Perspect. 9, 19–25 (1991). 8. Whipple, J. The Effect of Parent Training in Music and Multimodal Stimulation on Parent-Neonate Interactions in the Neonatal Intensive Care Unit. J. Music Ther. 37, 250–268 (2000). 9. Shahidullah, S. & Hepper, P. G. The developmental origins of fetal responsiveness to an acoustic stimulus. J. Reprod. Infant Psychol. 11, 135–142 (1993). 10. Lamont, A. & Dibben, N. Motivic Structure and the Perception of Similarity. Music Percept. Interdiscip. J. 18, 245–274 (2001). 11. Perry, C., Thurston, M. & Osborn, T. Time for Me: The arts as therapy in postnatal depression. Complement. Ther. Clin. Pract. 14, 38–45 (2008). 12. Favara-Scacco, C., Smirne, G., Schilirò, G. & Di Cataldo, A. Art therapy as support for children with leukemia during painful procedures. Med. Pediatr. Oncol. 36, 474–480 (2001). 13. Thomas, S., Mackintosh, S. & Halbert, J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing 39, 681–687 (2010). 14. Shubert, T. E. Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of the Literature. J. Geriatr. Phys. Ther. 34, 100–108 (2011). 15. Wittwer, J. E., Webster, K. E. & Hill, K. Music and metronome cues produce different effects on gait spatiotemporal measures but not gait variability in healthy older adults. Gait Posture 37, 219–222 (2013). 16. Goddaer, J. & Abraham, I. L. Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment. Arch. Psychiatr. Nurs. 8, 150–158 (1994). 17. Clark, M. et al. Use of preferred music to reduce emotional distress and symptom activity during radiation therapy. J Music Ther 43, 247–65 (2006). 18. Thomas, D. W., Heitman, R. J. & Alexander, T. The Effects of Music on Bathing Cooperation for Residents with Dementia. J. Music Ther. 34, 246–259 (1997). 19. Ashida, S. The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. J. Music Ther. 37, 170–182 (2000). 20. Tadaka, E. & Kanagawa, K. Effects of reminiscence group in elderly people with Alzheimer disease and vascular dementia in a community setting. Geriatr. Gerontol. Int. 7, 167–173 (2007). 21. Noble, A. & Jones, C. Benefits of narrative therapy: holistic interventions at the end of life. Br. J. Nurs. Mark Allen Publ. 14, 330–333 (2005). 22. Frank, A. W. Just listening: Narrative and deep illness. Fam. Syst. Health 16, 197–212 (1998). 23. Romanoff, B. D. & Thompson, B. E. Meaning Construction in Palliative Care: The Use of Narrative, Ritual, and the Expressive Arts. Am. J. Hosp. Palliat. Med. 23, 309–316 (2006). 24. Nancy A. Nainis MAAT, L., ATR. Art Therapy with an Oncology Care Team. Art Ther. 22, 150–154 (2005). 25. Repar, P. A. & Patton, D. Stress reduction for nurses through Arts-in-Medicine at the University of New Mexico Hospitals. Holist Nurs Pr. 21, 182–6 (2007).

The impact of the arts in

Medicine & Life Sciences - the evidence

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Singing can improve lung function and mental health in adults with chronic obstructive pulmonary disease.1, 2

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Music can increase gastric myoelectrical activity, gastric motility and gastric emptying and reduces nausea and vomiting.3–5

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Music during interventional radiology procedures, colonoscopies, spinal anaesthesia and in intensive care can reduce doses of sedative and analgesia.9–11

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Relaxing recorded music chosen by surgeons can improve their speed and accuracy in operating theatres.12–14

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Dance can lead to increased lumbar bone mineral density and markers of osteoblastic activity in osteoporotic older women.15

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GP surgeries with enhanced design have reduced patient anxiety, increased satisfaction with patient-doctor communication and improved staff satisfaction.16

Tablet devices using arts, music and games can be more effective than midazolam in reducing anxiety, delirium and time-to-discharge in children undergoing anaesthetic.6

Music-based movement therapy can improve balance, stride length and walking velocity in patients with Parkinson’s disease.7

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Virtual windows (artistic films of the outside world) can reduce anxiety and improve treatment experience in cancer patients undergoing stem cell transplantation.8

Video games explaining cancer treatments to children can increase medication adherence and promote healthy behaviours.17, 18

References 1. Bonilha, A. G., Onofre, F., Vieira, M. L., Prado, M. Y. A. & Martinez, J. A. B. Effects of singing classes on pulmonary function and quality of life of COPD patients. Int. J. Chron. Obstruct. Pulmon. Dis. 4, 1–8 (2009).

2. Clift, S. et al. An evaluation of community singing for people with COPD. 1–33 (Canterbury Christ Church University, 2013). 3. Vickers, A. J. & Cassileth, B. R. Unconventional therapies for cancer and cancer-related symptoms. Lancet Oncol. 2, 226–232 (2001). 4. Lin, H.-H. et al. Effects of music on gastric myoelectrical activity in healthy humans. Int. J. Clin. Pract. 61, 1126–1130 (2007). 5. Yamasaki, A. et al. The impact of music on metabolism. Nutrition 28, 1075–1080 (2012).

6. Seiden, S. C. et al. Tablet-based Interactive Distraction (TBID) vs oral midazolam to minimize perioperative anxiety in pediatric patients: a noninferiority randomized trial. Pediatr. Anesth. 24, 1217–1223 (2014).

7. de Dreu, M. J., van der Wilk, A. S. D., Poppe, E., Kwakkel, G. & van Wegen, E. E. H. Rehabilitation, exercise therapy and music in patients with Parkinson’s disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. Parkinsonism Relat. Disord. 18, Supplement 1, S114–S119 (2012).

8. McCabe, C., Roche, D., Hegarty, F. & McCann, S. ‘Open Window’: a randomized trial of the effect of new media art using a virtual window on quality of life in patients’ experiencing stem cell transplantation. Psychooncology. 22, 330–337 (2013).

9. Kulkarni, S., Johnson, P. C. D., Kettles, S. & Kasthuri, R. S. Music during interventional radiological procedures, effect on sedation, pain and anxiety: a randomised controlled trial. Br. J. Radiol. 85, 1059–1063 (2012). 10. Koch, M. E., Kain, Z. N., Ayoub, C. & Rosenbaum, S. H. The sedative and analgesic sparing effect of music. Anesthesiology 89, 300–306 (1998).

11. Lepage, C., Drolet, P., Girard, M., Grenier, Y. & DeGagné, R. Music decreases sedative requirements during spinal anesthesia. Anesth. Analg. 93, 912–916 (2001).

12. Siu, K.-C., Suh, I. H., Mukherjee, M., Oleynikov, D. & Stergiou, N. The effect of music on robot-assisted laparoscopic surgical performance. Surg. Innov. 17, 306–311 (2010). 13. Allen, K. & Blascovich, J. Effects of music on cardiovascular reactivity among surgeons. JAMA 272, 882–4 (1994).

14. Conrad, C. et al. The effect of defined auditory conditions versus mental loading on the laparoscopic motor skill performance of experts. Surg. Endosc. 24, 1347–1352 (2010). 15. Kudlacek, S., Pietschmann, F., Bernecker, P., Resch, H. & Willvonseder, R. The impact of a senior dancing program on spinal and peripheral bone mass. Am. J. Phys. Med. Rehabil. Assoc. Acad. Physiatr. 76, 477–481 (1997).

16. Rice, G., Ingram, J. & Mizan, J. Enhancing a primary care environment: a case study of effects on patients and staff in a single general practice. Br J Gen Pr. 58, e1–e8 (2008).

17. Barbosa, D. N. F. et al. in Games for Training, Education, Health and Sports (eds. Göbel, S. & Wiemeyer, J.) 153–164 (Springer International Publishing, 2014). at 18. Kato, P. M., Cole, S. W., Bradlyn, A. S. & Pollock, B. H. A video game improves behavioral outcomes in adolescents and young adults with cancer: a randomized trial. Pediatrics 122, e305–317 (2008).

What is Arts in Health? Some examples

Arts in the Healthcare Environment • Colour schemes and lighting to create relaxing wards • Artwork and films to distract in waiting areas • Gardens to enhance wellbeing • Personalised bed areas to rehumanise wards • Exhibitions and public concerts to uplift patients, staff and visitors • Artistic wayfinding to reduce disorientation • Background music to reduce anxiety

Arts in Psychotherapy • Drama therapy to reduce antisocial behaviour • Art therapy to express difficult feelings • Music therapy to communicate without words • Dance therapy to reconnect with the body

Arts and Health in technology Participatory Arts and Health programmes • Dance-physio classes for amputees • Dementia reminiscence sessions • Singing for chronic lung disease • Mental health drumming workshops • Museum object handling for people with Alzheimer’s • Magic tricks to improve motor skills in hemiplegia • Hiphop groups to reduce isolation in vulnerable teenagers

Arts and Health for everyday life • Learning an instrument to support cognition • Attending a concert to de-stress • Visiting a gallery to feel inspired • Leading a book club to grow social support networks • Taking up ballet for bone strength • Joining a pottery class to improve self-esteem • Listening to an iPod to improve mood

• Guided music and imagery for chronic pain • Live streaming of nature for patients in isolation • Relaxation films to reduce anxiety • Games apps for children having anaesthetics • Recorded lullabies to calm premature babies

Arts and Health for staff • Relaxation programmes to reduce burn-out • Photography to improve diagnostic skills • Music in theatre to help surgeons concentrate • Role play sessions to improve patient communication • Expressive poetry to improve job satisfaction • Staff choirs to enhance teamwork