5Th Croatian Symposium on Medicine and Music with International Participation

Fifth Croatian symposium on “MEDICINE AND MUSIC“ with international participation

Abstract book

Editors: Darko Breitenfeld, Mijo Bergovec, Marko Lucijanić

Publisher: MusicPlay, Zagreb 2010.

Fifth Croatian symposium on „MEDICINE AND MUSIC“ with international participation

Organizer: CROATIAN PHYSICIANS’ MUSIC SOCIETY, CMA, ZAGREB tel: +385 91 7383 023, email: [email protected]

When: 25th to 27th February 2010, from 09:00 - 19:00 h Where: Zagreb, University Hospital Dubrava, Avenija Gojka Šuška 6 Official languages: Croatian and English Presidents: D. Breitenfeld, Mi. Bergovec Vice presidents: M. Prstačić, L. Krapac, T. Breitenfeld Secretaries: M. Lucijanić, D. Perić, T. Lucijanić, D. Kust, R. Granić Sponsor: Mayor of Zagreb - Milan Bandić In cooperation with: City Hall, UH Dubrava, Croatian Composers’ Society, Music Academy in Zagreb, Croatian Society for Music Therapy, Faculty of Education and Rehabilitation-Zagreb University, „Music Play",Associations „Ruke“& "Life", Zagreb

CONTENTS

Thursday, 25th February 2010 Theme: MUSIC THERAPY Chairman: M. Prstačić

A. Petaros: Dance in medical tradition...... 10 I. Salopek: Music in the function of medical students education – presentation of the students group «In the honour of Asclepius and Orpheus» ...... 10 A. Lesac, G. Lesac: Influence of liturgic music on the health conditioned quality of life...... 11 M. Prstačić, A. Hanić, M. Marić, T. Bratim: Terpsichore – clinical dance ...... 11 D. Miholić: Music and psychodrama...... 11 A. Valiđić, M. Prstačić: Music and autism, anorexia and bulimia: rhythm and dance in supportive therapy ...... 12 R. Martinec, M. Prstačić: Music and art expression in diagnostics and therapy ...... 12 M. Tariba, M. Prstačić, M. Perasović, D. Pivac: Auguste Renoir, Claude Debussy and multidimensional approach in body image analysis with the concept of creative therapy ...... 12 L. Skoblar, M. Prstačić: Psychodinamics of painting, creativity and music ...... 13 Lj. Lerrman‐Skomina: Music therapy in children ...... 13 Mi. Bergovec: Physicians and music ...... 13 D. Breitenfeld: Medicine and music ...... 14 M. Prstačić:

Creativity, sophrology, music and therapy...... 14 R. Martinec, M. Prstačić, D. Breitenfeld, M. Prgomet, M. Marić, H. Strsoglavec: Rehabilitation, sophrology, creative therapies and art/expressive psychotherapies: Graduate study/University of Zagreb...... 15 B. Brezac‐Benigar: Music and autism ...... 15 V. Kos, M. Zubčić: Transactional analysis, theory of choice (reality therapy) and music therapy with intellectually disabled children and adults ...... 16 Lj. Radovančević, V. Lecher‐Švarc: Music therapy with PTSD patients...... 16 D. Kust, M. Lucijanić, I. Fattorini, D. Janigro: Art in prevention and therapy in Cleveland University Hospital...... 16 T. Stradovnik: Influence of music on drug addicted patients ...... 16 V. Celarec: Music therapy in Mental health centre in Ljubljana ‐ 35 years of practice...... 17 S. Poch‐Blasco: The role of the music therapist with mentally ill patients...... 17 J. Eschen: Analytic music therapy ...... 17 D. Tiljak‐Schmoll: Music therapy study in Augsburg – videopresentation...... 17 A. Fenwick: The relation between art therapies and arts in health ...... 18 G. Cremaschi Trovesi, C. Ravenna: “The vibrating body” music rehabilitation in children with special needs...... 18 A. Katušić, M. Prstačić: Vibroacoustics, rehabilitation and sophrology ...... 18 A. Antunović: Vibroacoustic therapy in rehabilitation ...... 19 O. Skille

Audiopharmacy...... 19 S. Day‐Salmon: Between freedom and ritual, presentation of DVD ...... 19 S. Poch‐Blasco: A case of PDD, autism, in adolescent boy with Savant syndrome...... 20 W. Szulc, A. Grzbielska: Pedagogic recreational music therapy...... 20 E. Galinska: The method of the Musical Portrait as a form of psychotherapy ...... 20 T. Novosel‐Weitzer: Music therapy in the department for psychosomatic – accent on somatiform pain and eating disorders...... 21 V. Vrbanić‐Majsec, Y. Schiftan: Use of musica‐medica in Croatia ...... 22 T. Novosel‐Weitzer: Free case reports – the variability of music therapy...... 22 I. Stojković: Music application in the emergency care ...... 23 E. Lecourt: Music therapy in France and abroad, psychotherapeutic aspects...... 23 Lj. Radovančević, V. Lecher‐Švarc: Correlation of music therapeutic and psychoanalytic aspects of neurosis treatment ...... 23 M. Marković: Eastern music as therapy...... 23 K. Bakota, D. Obad, G. Koščec: Music effect exploring of behavior and creativity in children with special needs...... 24 Z. Tomašić Sacral Music and Mental Health...... 24

Friday, 26th February 2010 Theme: MEDICAL DISORDERS OF PERFORMING ARTISTS Chairman: L. Krapac

J. Grah: Respiratory system anatomy and physiology in playing brass instruments ...... 25 A. Bonevski, T. Lucijanić: Health of musculo‐skeletal system in dancers ...... 25 A. Bonevski, T. Lucijanić: Lifestyle of professional dancers ...... 25 A. Šeketa‐Gleich: Personality of ballet artists ...... 26 Mi. Bergovec, A. Popović, T. Lucijanić: Zagreb Musicians’ health Centre...... 26 M. Lucijanić, D. Breitenfeld: Health of performing musicians ...... 26 T. Novosel‐Weitzer, D. Breitenfeld: Musicians Performers’ medicine a hundred years ago ...... 27 Mi. Bergovec, D. Lucijanić, T. Lucijanić, J. Miletić: Analysis of high intrathoracal pressure...... 27 R. Granić, D. Breitenfeld, D. Buljan, F. Grubišić: Stress and development of psychiatric disorders in performing musicians...... 27 A. Kopić, D. Breitenfeld: Medical conseqences of conductors’ lifestyle...... 27 J. Meštrović‐Štefekov, J. Lesić, D. Perić: Consequences of performing on skin and mucosa ...... 28 D. Lucijanić, M. Lucijanić, Ma. Bergovec: Surgical approach in treatment of performing musicians ...... 28 B. Perić, D. Kust, D. Breitenfeld: Abuse of addictive substances in performers of different music styles ...... 28 D. Kust, D. Breitenfeld, A. Akrap: Effect of competitive environment on personalities of young performers ...... 28 B. Starc: Vocography and its application in vocal‐technical anlysis and diagnosis of the voice...... 29 G. Ivkić, T. Breitenfeld, G. Armano, D. Breitenfeld: Cerebral interpretation of music...... 29

D. Breitenfeld, T. Breitenfeld, V. Demarin: Neurokinesiology of playing dexterity ...... 29 L. Krapac, F. Grubišić, D. Breitenfeld i M. Lucijanić: Overused arms and hands in professional musicians ...... 30 D. Kristović, L. Krapac, D. Breitenfeld, A. Delija, A. Kopić, D. Juran: Consequences of keyboard playing ...... 30 L. Krapac, M. Škrgatić i Z. Kalafaić: Morphologic changes of cervical spine in «homo sedens» ...... 30 F. Grubišić, L. Krapac: Physiatric problems of the musculoskeletal system in performing musicians...... 31 L. Krapac, A. Delija, D. Breitenfeld, Ma. Bergovec: Working chair of professional musicians ...... 32 D. Srdoč: Diagnostic approaches in overuse syndromes ...... 32 S. Rucner: Mental health and musicians’ disorders ...... 33 M. Lucijanić, T. Breitenfeld, G. Ivkić, J. Miletić: Common canalicular syndromes in performing musicians...... 33 M. Vodanović, V. Hutterer, Ž. Jurašinović: String players’ diseases...... 33 E. Lecourt, D. Kust, D. Breitenfeld, A. Kopić, M. Prstačić: Medicine and music in France, performing musicians, etc...... 33 M. Lucijanić, L. Krapac, D. Breitenfeld, J. Miletić: When does an overuse injury occur and how to manage it?...... 33 L. Bergovec, M. Kereković, D. Breitenfeld: Singers’ «lost» voice...... 34 M. Mlinac‐Lucijanić, T. Lucijanić, B. Perić, D. Lucijanić: Doctor’s responsibility...... 34 T. Barčan, M. Šubarić, Ž. Jurašinović: Hearing problems in performing musicians ...... 34

Saturday, 27th February 2010

Theme: DESTINIES AND DISEASES OF COMPOSERS Chairman: T. Breitenfeld

B. Perić, D. Kristović, A. Kođić, L. Bergovec, Ma. Bergovec, D. Breitenfeld: Destinies of composers ‐ pianists ...... 35 D. Lucijanić, D. Breitenfeld, Š. Ozimec‐Vulinec, M. Župančić, Z. Stahuljak: Diseases of musicians’ family Stahuljak ...... 35 D. Lucijanić, D. Perić, S. Vukovojac, D. Breitenfeld, D. Juran: Diseases of musicians’ family Dugan ...... 35 T. Barčan, M. Šubarić, D. Lucijanić, G. Babić, D. Breitenfeld: Deafness in composers...... 35 L. Bergovec, G. Rujevčan, Mi. Bergovec, D. Breitenfeld, I. Prošev, D. Feletar: Diseases of Međimurje composers...... 35 D. Breitenfeld, A. Kopić: Destinies, diseases and creativity of lawyers composers ...... 36 D. Breitenfeld, J. Korpar, I. Špralja, M. Mlinac‐Lucijanić, D. Juran: Croatian composers executed in World war II ...... 36 P. Kornhauser: Sexual deviation of Tschaikovsky...... 36 M. Lucijanić, D. Breitenfeld, M. Mlinac‐Lucijanić, E. Galinska, W. Szulc: Diseases of Polish composers...... 36 S. Poch‐Blasco, M. Lucijanić, D. Breitenfeld: Diseases of Spanish composers...... 37 C. Ravenna, G. Cremaschi, T. Breitenfeld: Diseases of Italian composers ...... 37 T. Novosel‐Weitzer, D. Breitenfeld: Diseases of Austrian composers...... 37 D. Breitenfeld, D. Kust: Diseases of German Composers...... 37 J. Čić, D. Breitenfeld, D. Kust: Haydn, Liszt – Burgenland composers ...... 38 D. Breitenfeld, M. Lucijanić, D. Kust: 2010. Jubilareans: Schumann, Chopin, Mahler, Pergolesi and Wolf ...... 38

V. Demarin, S. Antić: Music as stimulus in patients with stroke ...... 38 E. Lecourt, D. Kust, D. Breitenfeld, M. Prstačić: Diseases of French composers ...... 38 M. Vodanović, D. Breitenfeld, O. Skille: Diseases of Scandinavian composers...... 39 Y. Schiftan , M. Lucijanić, J. Miletić, M. Turina, D. Breitenfeld, V. Vrbanić: Diseases of Swiss composers ...... 39 A. Fenwick, M. Lucijanić, J. Miletić, D. Breitenfeld: Diseases of British composers...... 39 I. Fattorini, D. Janigro, M. Lucijanić, M. Vodanović, D. Breitenfeld: Diseases of American composers ...... 39 T. Breitenfeld, V. Demarin, D. Breitenfeld: Stroke in baroque composers ...... 40 T. Breitenfeld: Creativity and brain ...... 40 P.Kornhauser, Z. Slavec‐Županič, V. Celarec, S. Pettan, D. Kust, D. Breitenfeld: Disease in Slovene composers ...... 40 I. Stojković, M. Marković, D. Breitenfeld: Diseases of Serbian composers ...... 40 J. Miletić, M. Lucijanić, M. Mlinac‐Lucijanić, D. Breitenfeld: Famous composers of «small nations» (Enescu, Sibelius, Villa‐Lobos and others) ...... 40 J. Blaić, I. Blaić‐Dediol, D. Breitenfeld, D. Lucijanić: Early death of Dora Pejačević...... 41 T. Breitenfeld, V. Demarin, D. Breitenfeld, D. Buljan: Neurologic and psychiatric diseases of composers...... 41 J. Gjurović, D. Kust, D. Breitenfeld, Lj. Bjelinski: Diseases of Bruno Bjelinski ...... 41

SUMMARIES

Thursday, 25th February 2010 Theme: MUSIC THERAPY Chairman: M. Prstačić

A. Petaros: Dance in medical tradition The main goal of this presentation is to show how dance was used in medical practice of different cultures at different times, and to investigate its role in many pathological processes, focusing on Croatian dancing tradition. The healing power of dance has been used in many different ways; for centuries it was offered as a tribute to gods; in other cultures it improved mental and physical state by influencing the flow of vital corporeal energy. On the other hand, many diseases have been associated with dance through the history such as chorea, ergot poisoning, epilepsy, and sunstroke. Legends, facts and curiosities referred to in this presentation reveal the enchanting world of dance history and the role that it played in the forming of modern medicine, which now seems to rediscover its benefits for human health.

I. Salopek: Music in the function of medical students education – presentation of the students group «In the honour of Asclepius and Orpheus» Doctors' special inspiration and creativity is often requiered for the successful application of medical knowledge and skills in diagnostic and therapeutic procedures. Art of medicine (ars medica) is especially expressed by the possibility of using the entire medical knowledge and science in the individual treatment of patient, and creating high-quality doctor-patient relationship. In contrast, conventional art, like music (ars musica) is integrated part of the humanistic character of medical profession and as such indispensable in the education of good doctors. Interlacing music and medicine, for several years at the University of Rijeka School of Medicine, exists students group called «In the honour of Asclepius and Orpheus». The group is the part of the Croatian Scientific Society for the History of Medicine, and performs activities under the guidance of Professor Ante Škrobonja. In order to affirmate the link between the medicine and music, and substitute scientific constraints of medical studying «Asclepians and Orpheans» organize thematic studies and appropriate lectures, participate in congresses with medical and historical topics, carry out joint international projects, prepare distinctive designed concerts . The last one was the First humanitarian concert of croatian medical students - held in Rijeka at the end of 2009. In conclusion, it is necessary to enable the systematic inclusion of a number of medical students interested in activities with artistic contents.

A. Lesac, G. Lesac: Influence of liturgic music on the health conditioned quality of life The quality of life (QOL) is a complex item. It includes factors refering to the pathological status itself and social and economic changes caused by the illnes as well. Also, it includes phisycal and mental changes that medical personel does not value, such as sexual disfunctions, cognitive disorders, mood changes. The basic question of this research was: does the listening of the liturgic music effect on the QOL? If does, is the effect different from the effects of other types of music, and what are the most important changes refering to QOL? A standard questioner for QOL, SF36 was used. Also, visual analog scale was used in order to valuate the changes refering to headache, tyredness, angryness, anxiety and bad sleeping. For the valuation of chronic reumatic pain, a modiffied McGill's questioner was used. Blod pressure was meshured as well. Liturgic music strongly modiffied some aspects of health, such as the perception of headache, anxiety and agressive behaviore, and turn out to be a factor that improoves the QOL.

M. Prstačić, A. Hanić, M. Marić, T. Bratim: Terpsichore – clinical dance With regard to the Greek classical mythology and arts (Terpsichore – Τερψιχόρη - "delight of dancing" was one of the nine Muses, ruling over dance and the dramatic chorus, etc.), some contemporary aspects of dance (ballet) have been considered, as well as of dance pedagogies, complementary application of contents from the fine arts and music, and the development of a concept of the so –called analytical posturology and body symbolisation in diagnostics and therapy. A hypothesis has been defined, acccording to which – with application of acoustic, visual and postural stimulation in the guided imagination method in creative therapy (integrative somatotherapeutic and psychotherapeutic approach) – it is posssible to induce a hypnagogic state of consciousness in the subject, which is manifested in imaginative associations and experience of aesthetic pleasure. The purpose of such an approach is to facilitate attainment to new levels of introspection and self-assessment.

D. Miholić: Music and psychodrama As a symbolic and creative expression, music and theatre/drama are found on the same historic continuum of human experience. They grew out of rituals as a form of cohesive activity of a community or an individual; mystical elements of power were attached to them; they were a remedy for both body and soul. Development of art/expressive oriented psychotherapeutic methods includes music and drama expression (and other art media) in the function of (re)integration of personal biopsychosocial and existential experience, processing and changes of psychopathological components, and development of a spectrum of new mechanisms of experience and behaviour in the function of

releasing and encouraging creative adaptive potentials in a person in various problem fields. Although psychodrama and music therapy have been developing as two separate psychotherapeutic tools, psychodrama in its structure can apply the elements of music, and vice versa: music therapy can apply the elements of stage/drama (verbal and/or non-verbal) expression. Starting from this thesis, the paper will present some theoretical considerations and practical experience about the possibility of including music into the structure of drama/psychodrama therapy sessions.

A. Valiđić, M. Prstačić: Music and autism, anorexia and bulimia: rhythm and dance in supportive therapy In some disorders like bulimia and anorexia are psychotherapeutic as well as organic measures necessary. Art expression, especially motoric one combined with music – dancing enables creativity and art expression ameliorating the symptoms of the disorder. Motoric expression is especially important when is followed by music and performed actively (like dance therapy). Rhythm is accentuated as a key component of such therapy. Music elements have special effect if they are recognizable by a client.

R. Martinec, M. Prstačić: Music and art expression in diagnostics and therapy During the whole medical attitude with the patient, starting from diagnostic and therapeutic procedures, artistic approach is possible and even recommended. Art expression enriches the personality of patients enabling to express themselves emotionally and physically. We aiming for an emotional component of a person and trying to relieve anxiety condition that often dominate in the patients. Artistic expression is part of a holistic approach to patient with predominantly pathopsychological content.

M. Tariba, M. Prstačić, M. Perasović, D. Pivac: Auguste Renoir, Claude Debussy and multidimensional approach in body image analysis with the concept of creative therapy In this paper creative therapy concept is used to present some forms of visual art as well as paintings by the author of the paper inspired by works of Auguste Renoire and Claude Debbussy. The research covered five evaluation points. Evaluation involved use of PD modified visual-analogue scales of self- assessment for two problem areas: figure and tree painting. First hand results for controlled variables are represented by tables and graphs representing tendencies of changes registered in these five evaluation points. The author's painting represents the idealization of ancient role model (archetype) of female body in line with the starting thesis and from the point of view of psychoanalysis, psychology of creativity and visual arts education. Observation protocols applied might be used for development of more complex research and interdisciplinary

approaches striving to study psychodynamics of visual arts creativity in different areas of education, diagnostics and therapy.

L. Skoblar, M. Prstačić: Psychodinamics of painting, creativity and music Since the time when Man became aware of this adventure on this planet, he has been discovering various forms of connection between the rhythms and music of the nature, his own body and existence… Psychodynamics is the systematized study and theory of the psychological forces that underlie human behavior, emphasizing the interplay between unconscious and conscious motivation. Painting is presented as a mode of expression and the forms are numerous. Drawing, composition or abstraction and other aesthetics may serve to manifest the expressive and conceptual intention of the subject, in diagnostics, education or therapy. As sister arts, music and painting share a common vocabulary. Colours have tones and harmonies while both arts are often referred to as compositions. In art expressive (psycho)therapies, for example, the mouth and the lips are often viewed as a symbol for sensuality and sexuality. Reality of self-perception and self-esteem is created by colours, sound, tones, harmonics... This has many origins; above all, the lips are a very sensitive erogenous and tactile organ... In the frame of this approach some aspects of Carl Jung's contributions in psychodynamic psychology include: the psyche tends toward wholeness; the Transcendent Function: the emergence of the third resolves the split between dynamic polar tensions within the archetypal structure…

Lj. Lerrman-Skomina: Music therapy in children Here is presented how is music therapy being applied in children, who is a candidate for music therapy, technique of active and receptive music therapy, how to choose adequate music and how to educate therapists. Therapist education and his experience are very important, because it is a fundamental requirement for professional and scientific approach and success in music therapy. Music must be acceptable to the candidates. An active approach is the most successful one.

Mi. Bergovec: Physicians and music Many doctors throughout history contributed to the development of music, worldwide and in Croatia. Music and medicine has been connected since prehistoric times when magic rituals that included dancing and music were held till today when we can meet and hear singing choirs and music ansambles composed of health professionals. There are 4 singing choirs in Croatia today composed of physicians. Baglivi, Bajamonti, von Helmholtz, Billroth, N. Kalogjera are only few names of other mentioned significant physicians. Superior form of medical approach to music and talented performing musicians who are suffering

to some extent is special Health Center for artists – musicians like one in KB Dubrava.

D. Breitenfeld: Medicine and music We introduce the connection between music and medicine not only in terms of terapeutic possibilities of music, but also in terms of dangers caused by professional music by performing and pathographies of famous composers. In terms of musicotherapy, we can say that she includes holistic approach in treatment of psychic disorders, addictions, psychosomatic diseases and when in active application. Everyday effect of musicotherapy is also very important because it relaxes and strenghtens our inner mechanisms. Problems of professional musicians are most often caused by overloading and creating excessive demands on a number of very fine muscle fibers, which are often highly burdened by improper technique. Some composers like Schumann have had problems with the most sensitive fourth finger of the hand, and the composer suffered from hereditary depressive disorders caused by certain proven dissociated disorders of thinking. We described the fate of dozens of composers from the pool of 1500.

M. Prstačić: Creativity, sophrology, music and therapy …In the study of development of consciousness as a cosmic phenomenon, one faces also the traces of ancient rituals in which man, by means of his voice and body, by rhythm, sculpture, colour… attempted to express his discovery of life and spirit, creating thus the systems of symbolic and sign messages, important for his existence. ...Sophrology is an interdisciplinary area considered as the philosophy and science of the consciousness and values of existence...... In this symbolism word, sound, colour, melody, rhythm, dance as well as voice, heartbeat, intestinal noise, smell, touch, body image and imagination…, as media, can offer new possibilities in the discovery and support of subjectivity and life potential… Experience from various scientific disciplines and arts are intertwined, which enables an individual to have an aesthetic experience as a spiritual, psychological and gnoseological intentional act of consciousness... …As the essence of this and any other phenomenon has its aesthetical character, the development of aesthetical experience in an act of creation could be thus explained as a result of the development of perceptive consciousness and metaphysical intuition which permeates that being: the truly and absolutely beautiful is always elevated, and the elevated (if it is true) is beautiful, writes Schelling in his system of transcendental idealism. From the psychosomatic, i.e. somatopsychic aspect, the aesthetic experience, or rather the aesthetical dimension of existential experience comprises a large part of the substrate in perception mechanisms, and includes the internal biological and spiritual rhetoric of comfort and discomfort, pain and pleasure, existential values and psychosocial influences, as well as the possibilities of induced creative imagination…

...While language and thinking are becoming more and more technical-scientific, creativity and cosmic responsibility of man should se seen through the search for new answers to a number of questions on the formation of human thinking, which thinks itself, and the logos, the sense, the cosmos, the theos ...

R. Martinec, M. Prstačić, D. Breitenfeld, M. Prgomet, M. Marić, H. Strsoglavec: Rehabilitation, sophrology, creative therapies and art/expressive psychotherapies: Graduate study / University of Zagreb “…Thus art as an abstraction and existential communication comes close to the fundamental ontology as a form of expression and discovery of transhistoric and transcultural dimensions of existence and man’s needs…On the same basis one should also consider the development of professional identity and the importance of interdisciplinary approaches in the complex field of creative therapy and art/expressive therapies, as well as the development of education in this field at different university and clinical institutions worldwide… The terms (synonyms) such as art therapy, creative art therapy, art psychotherapy and expressive art therapies imply specific professional fields in a broader sense: music therapy, dance – movement therapy and body symbolisation, drama therapy and psychodrama, art (painting) psychotherapy, creative therapy, art sophrotherapy…” … At the Department for the Studies of Motoric Disturbances, Chronic Diseases and Art Therapies at the Faculty of Education and Rehabilitation Sciences UNIVERSITY OF ZAGREB, the first scientific postgraduate and doctoral studies in the study field of Motor Disorders, Chronic Diseases and Art Therapies were completed. Furthermore, within the Department, the interdisciplinary field of sophrology is being developed as a new paradigm in the field of education and rehabilitation sciences. Within the studies module of “Rehabilitation, Sophrology, Creative and Art/Expressive Therapies”, the studies program and competencies of graduated experts are based on connections of knowledge in various fields of biomedical, humanistic, social and other sciences, as well as various fields of arts. Departement is member of The European Consortium for Arts Therapies Education (ECArTE) since 2004.”

B. Brezac-Benigar: Music and autism This work brings out the method, importance of the use and effects of music therapy treatments on individuals with autistic spectrum disorder. There is the reveal of the of the perception ways and specificity of the individuals that show deviation and very pointed dissabilities in sensory integration which means that senses make experiences which are below the expetations (hipo sensitivity) or on a higher level (hiper sensitivity). The senses that act by that key are sight, hearing, olfactory sense, taste and touch. The disharmony in sensory system is present on each person differently in and on the body. The work discribes different phenomens which open the communication chanels by using this

nonverbal therapy method and they also develop speach skills. Music therapy has also a goal to engend social skills and make wide pallete of the emotional scale of experiences. Inseparably from music there is mentioning of movement as an important factor which together with music leaves positive consequences on motor and cognitive development of the individual. Music and movement are contribute to the sensory integration in a special way by bringing the individual in balans closer to the harmonic reactions. They also make improvement on general funcioning in their final results which reflects directly on quality of life of the individual with autistic spectrum disorder.

V. Kos, M. Zubčić: Transactional analysis, theory of choice (reality therapy) and music therapy with intellectually disabled children and adults Intellectually disabled children and adults can be therapeutically reached by many methods, here is the accent done on the transactional analysis, theory of choice (reality therapy) and music therapy. There are also reactive and anxious- depressive states present, and therefore provided and implemented methods are comprehensible. It is very important to emphasize that the widespread acceptance of music is important.

Lj. Radovančević, V. Lecher-Švarc: Music therapy with PTSD patients In this paper the author submittes the possibilities of the music-treatment of the Croatian defenders based on the work experience of the Organisation of the family defenders who suffer from PTSP. The music-therapy had been implemented throughout dance classes that took place in the Organisation.

D. Kust, M. Lucijanić, I. Fattorini, D. Janigro: Art in prevention and therapy in Cleveland University Hospital Iva Fattorini is chairman of Arts&Medicine Institute in Cleveland and she is investigating new methods of music therapy as well including artistic approach enriching the rooms with artistic pictures and sculptures. Besides encounters with artists and performing musicians during and after concerts. Music enjoying is used too.

T. Stradovnik: Influence of music on drug addicted patients There are 18 Centers of drug prevention in Slovenia. Center of Drug Addiction in Ljubljana began to work in 1995. Treatment in this Center has three phases. In the first two there are hospitalized patients, in the third there are out-patients. Group music therapy is included in treatment program of second and third phase and is based on the principle of general treatment programs in Center-that is on psychosociotherapy. Music therapy in the second treatment phase lasts 8 weeks and patients can join it voluntarily. In the third phase, which lasts 6 months, music therapy is obligatory for all patients of this day-care treatment. Music therapy is performed in passive form once a week for 45 minutes. The paper

describes the influence of listening to concrete music composition (R.Wagner :The ride of Walkure) on drug addicted patients in music therapy sessions in second and third phase of treatment.

V. Celarec: Music therapy in Mental health centre in Ljubljana - 35 years of practice In Mental health centre in Ljubljana (Slovenia), which is an integral part of Psychiatric Clinic Ljubljana, group and individual music therapy are included in treatment programs of all six Units: -for crisis intervention, -for adolescent psychiatry, -for eating disorders, -for alcoholism -for neurosis and -for psychosis. In all Units the treatment is based on psychotherapy so also the author of this article had to complete studies on psychotherapy. She explains the programs and methods of music therapy, used in individual Units, and describes various experiences of 35-years-practice of her work. Some concrete music compositions that have been most effectively used in receptive group music therapy are also listed.

S. Poch-Blasco: The role of the music therapist with mentally ill patients The objective of this study is to point out the importance of the qualities, and personality of the music therapist who works with psychiatric patients. And the functions of one´s own. Without some essential qualities, even with a very good professional preparation, will not be a good music therapist. Another important condition it is to have vocation for that profession, which it is indispensable because it is a hard work, more than it can seems, but very personally rewarding as all professions that it finality it is to help the human being, especially with emotional problems.

J. Eschen: Analytic music therapy Music therapy was with the advance of psychoanalysis applied also in this way. In the last homeland of Freud were developed such types of therapy (M. Priestley). This methods were applied also in Germany due to activities of J. Eschen who explicated his views, methods and results in his recommendable book “Analytic Music Therapy”. Here are analyzed few chapter of the book, and outlined the benefits that come from this kind of applied music therapy, especially in deeply neurotic changed clients.

D. Tiljak-Schmoll: Music therapy study in Augsburg – videopresentation University of Augsburg hosts the MA Studies of music therapy since 2004. The study is 3 years long. 11 students have finished the study, 11 are in the 6th semester, and 7 are in the 3rd. Since last year Augsburg is the host of the Workshop for research in music therapy, which annually brings together the music therapists and students from Germany, as well as Austria and Switzerland. In the 15 min-long movie you will be able to meet the study in Augsburg, after

17 which a short oral presentation on the music therapy studies in Germany will take place.

A. Fenwick: The relation between art therapies and arts in health Healthy way of living includes work and within human relations, recreation, creation too. Described are the possibilities of art therapy in concrete cases with psychological programs. Furthermore, some particularly good opportunities of applying all kinds of artistic approaches are accentuated.

G. Cremaschi Trovesi, C. Ravenna: “The vibrating body” music rehabilitation in children with special needs In all our gestures, moment after moment, there is a rhythm, a time, a music. When did our gestures originate? Movement is the very origin of the life. The body is the protagonist of the listening and of the production of the voice. Every sound or noise produced by the voice, depends on the breath. The corporeity is completely involved for the breathing. The emotions, any kind of emotion, create modifications in the whole corporeity, so they influence the breathing as well. The emotions derive by the relations with external world, others, ourselves. Re – spire. In this word there is the term “Spirit”. The voice originates by the relation with the air, considered as spirit. Even the life of the earth depends by the air, by the atmosphere. The renewal of this relation is the retaking of the breath, man’s wind. As the wind makes the nature singing or trembling, so happens for our voice. Any our breathing tells about our relation with the world, with the other, with ourselves. The human being is born endowed with the capacity to imitate gestures, voices, sounds. The neuroscience attribute this capacity to the mirror neurons. This capacity allows us to observe for reproducing, to make the surrounding reality own. The arts reach the top of these capacities. Music is constructed on the principle of imitation. The verbal language is founded on the principle of imitation. Every our gesture passed through imitative ways. The no– verbal generates the verbal language. The verbal is inside the no-verbal language.

A. Katušić, M. Prstačić: Vibroacoustics, rehabilitation and sophrology Recent understandings from the biomedicine, humanistic sciences and science of art indicate the importance and application of integrative and holistic approaches in different fields of education, therapy and rehabilitation. Observing the human in the concept of sophro-analysis and sophro-therapy, we can see that interventions are based on esthetics and art media as sound and vibration. This paper will present the results of clinical research, that is carried out on the sample of six children with neurological movement disorders, in the shape of six case studies. Within a framework of special prepared protocols for diagnostic, therapy and evaluation, the programm was conducted in fourteen assessment points. The basic hypothesis is defined, which refers to the interpretation that

application of different stimulation forms – as vibration, effects on induction of neurological chain reactions, the performance of self initiative movements, the motion activity and the experience of esthetics pleasure in subject. Seven controlled variables (body weight, body temperature, sistolic blood pressure, diastolic blood pressure, heart rate, range of movement and mimic expression of emotional states) were embraced by the research. The elaboration of results is accomplished by use of INDIFF programm. The results points to positive tendency changes in physiological and psychoemotional behaviour of subjects in connections to value decrease of blood pressure and heart rate and increase of range of movement. The gained results confirm the set hypothesis about effects of different art media on induction of neurological chain reactions in subjects.

A. Antunović: Vibroacoustic therapy in rehabilitation Vibroacoustic therapy (VAT) is a method of using low frequency, sinusoid sound for therapeutic purposes. Sound is transmitted on a body of a patient by vibroacoustic unit (Skille, 1991). As previous researches stated, use of complementary, integrative and holistic methods is most effective in discovering adaptive energy potentials in a person. Goal of this work was to examine influence of acoustic stimulus on changes of physiologic behavior in a child with neurologic impairment. It’s considered that sound waves of lower frequencies are transmitted through sensoric neural pathways and treat central nervous system, motoneurons and endocrine system. Vibrating the whole body can relax and reduce the muscle tone. Effect of selective acoustic stimuli on induction of neurologic chain reactions can be seen in performing a voluntary movement. Results are promising and they show the need for new researches in this field.

O. Skille Audiopharmacy The physicisists Thomas Heimburg and Andrew Jackson say that the classiscal theory is wrong. The electrical signals are not sending messages anywhere. They are just by-products of the real nerve signal that is made by a sound wave that passes through the nerve membrane and compresses it. The nerve acts like a tube. 40.000 hours experience based research since 1980 is presented here. Most used is single frequency, patient is in direct contact with sound source surfac with sound exposure time of 23 minutes. Transducers give vibration to the whole organism. By focal pain, the whole body is vibrated. Every cell in the body is treated.

S. Day-Salmon: Between freedom and ritual, presentation of DVD Part one, History and Development gives an insight into the practice of Elemental Music and Dance Education according to Orff-Schulwerk with people with disabilities at the Orff Institute. Wilhelm Keller (1920 – 2008) pioneered the use of Orff-Schulwerk with people with and without disabilities and always looked for the

creativity and individuality in each person. His groundbreaking integrative/ inclusive work was continued and developed further by his students. Part two, Insights into Practical Work shows examples from a group of adults with diverse disabilities who came to weekly sessions at the Orff Institute. In the course of one academic year 6 sessions were filmed and ‘special moments’ selected. Part three, Background and Reflection complements parts I and II and poses various questions. First, excerpts from a discussion with the wardens of the sheltered workshops and students of the Orff Institute who were in this teaching practice group are shown. These are followed by excerpts from an interview with Karin Schumacher in which questions concerning participants, goals and approaches are addressed.

S. Poch-Blasco: A case of PDD, autism, in adolescent boy with Savant syndrome This intervention it is based on the clinical experience of many years in the treatment of children with infantile autism or autistic behaviour, starting in 1966 with Dr. Lauretta Bender in Creedmoor State Hospital, N.Y., USA. These is the case of an adolescent boy with probably Pervassive Development Disorder, Autistic Spectrum, with Savant Syndrome. After the treatment of 67 cases, this case is the first with Savant Syndrome, showed in out of normal memory : musical memory and facility to learn languages. Actually he speak :Catalan, Castilian and French. The latter he learned it by reading the diccionary of this language. The weak point of his personnality is his emocional life, at the level of a child.

W. Szulc, A. Grzbielska: Pedagogic recreational music therapy The main topic of the presented work was implementation and evaluation of the Mobile Music Recreation Model during music activities in primary school and its role in lowering the frequency of aggressive behaviors of children. Music as an art integrate the human search for meaning, i.e. we can develop children’s personality through musical activities, prevent hyperactive attitude, increase cooperation inside of the group class. The conclusions from the research prove that in case of children showing signs of aggressive behaviors the use of the Model of Mobile Music Recreation is efficient as it rationalizes them physically and psychically. MMRM improved the relations and integration among the group members., which positively affected children’s emotional development. The research which was carried out shows that music has a huge therapeutic influence on children showing aggressive behaviors.

E. Galinska: The method of the Musical Portrait as a form of psychotherapy Musical Portrait (PM), devised by Elżbieta Galińska, is a method of group music therapy which refers to diagnosing and regulation of self-structure for non- psychotic patients. Self means here a process of constructing the meanings, applied on the base of the theory of evaluation which is carried by the patient.

One of the aims is to make changes in these meanings (the principle of reframing). PM provides a set of techniques: 1) receptive – a collage of three pieces of music as a mirror of three-layered structure of self, which includes both the public and hidden level of self and the prospective and potential level which is the integration of the previous ones; 2) improvised – with using of musical instruments (e.g. the musical-mirroring technique – a social self of the patient played by members of the therapeutic group and a musical expression of self); 3) psycho dramatic – a play on a scene according to the rules of Moreno’s psychodrama which refers to the main problem/ internal conflict of the patient and the reparation of traumatic experiences which is finished with therapeutic work in “surplus reality”. The single session of PM for one patient lasts 2 hours. The PM method of E. Galinska were presented with Polish music therapy in Music Therapy: International Perspectives (Eds. Ch. Delio Maranto,1993) and in the book of E. Lecourt:. La musicotherapie. Paris 1988, Presses Universitaire de France. It was also a subject of Master’s theses on musicology and psychology at Warsaw University.

T. Novosel-Weitzer: Music therapy in the department for psychosomatic – accent on somatiform pain and eating disorders Musicians and their pains, in view of professional injury and illnesses, are common subject. Although most injuries happen by nature of their work, it is necessary, if we want to consider the whole human being, to look at them through the perspective of psychosomatics. By looking at four different presentations of psychosomatic illnesses it is evident that inner emotional world of a musician often expresses itself through physical manifestations. It is important to emphasize that the sound and elements of music (rhythm, melody, dynamics, tempo, expression) follow a human being from the start and are important in forming the perception of ourselves and all that surrounds us. Formation of a musician personality is imbued by influence of music. It effects bio-psychic growth and development of his being, the formation of his social ties and relationships, his work, his material and lifestyle choices, his organization of free time and it’s meaning. If music pedagogy is to lose the sight of that complexity, turning into “training to learn the skill”, it will result in psychosomatic disorders or damage to the “chord” – the young future musician – "three sound" of body, mind and soul. It is, therefore, necessary for the music teacher not to lose the sight of comprehensiveness of his field, and to incorporate his musical biography into the professional growth. By introducing the elements of music therapy into the teaching process it is possible to perceive psycho-physical blockages in it's early stages, and mitigate or eliminate them altogether. Although music therapy is considered inappropriate for musicians, it is nevertheless possible to expand the contact with music and it's essence through (psycho) music therapy process, expose the role that music plays in the development of various structures of life and with it, give ones music new meaning and broader horizons.

V. Vrbanić-Majsec, Y. Schiftan: Use of musica-medica in Croatia Music is created by the heart and – just like a cosmic ocean – it moulds the shores of our senses, floods them, takes away and brings back new emotions, creating the joyful curiosity which shaped the thoughts of Aristotle, Bloch, and Beethoven. In the same way it shapes the thoughts of a little child, who – stimulated by music – starts to get familiar with its immediate environment. The way in which we experience music greatly depends on the innate capacity of our neurological system and it is different as the people differ among themselves. However, both the great composers and the children with development difficulties most likely have the same morphological and functional base. It's up to us to stimulate this auditory perception so that the child experiences the sound not only as an impulse, but as a sensation – a multiplied impression which will enhance the better understanding of the world around him. Music is an inseparable companion to the man from birth until death and its healing effect has been known to everybody since time immemorial. Therefore, if there is anything that people have in common on our planet, regardless of huge differences which set us apart, it is music. However, it is not only a „lyric cobweb between the heart and the brain“; moreover, it is literally a part of the mosaic which we can use in order to make up all the missing elements in creating a living of children and adults as well. Musica Medica is a modern non invasive method of stimulating the human body and brain using music with vibration. It uses two sensory inputs – touch – transmitted via two small transducers which are applied to different parts of the body, and hearing via traditional headphones, to initiate enhanced brain reactions based on the principles of vibro-acoustics. .

T. Novosel-Weitzer: Free case reports – the variability of music therapy In context of psychosomatics, we can characterize music therapy as a form of psychotherapy. One of the main goals for patients with chronic pain is to (re)connect with their emotions. Since large number of chronic pains is psychosomatic in nature, connection with emotions enables the "shift" of pain from purely physical into emotional sphere, mobilizing patients whole being - body, soul and mind - in confronting and resolving the problem that caused the pain. Recognizing emotions and their appropriate nonverbal expression in safe confines of music therapy process activates creative abilities and facilitates new forms of communication. Sense of security and trust between the therapist and patient in musical therapy process enables the corrective experience aspect of human relationships and bonds. Activating the creative potentials and sense of self as a "creator" and "active participant" in patients therapeutic process strengthens self-confidence and starts the systems of self-regulation. Imagination overcomes inner resistance and fear of "forbidden emotions" while providing them with expression through creative act. Traumatized patients can, in that safe and indirect manner, deal with repressed traumas processing and integrating

22 them. Inclusion of time parameters (past, present and future) in therapeutic process and their verbal and non-verbal expression brings intensive dynamics into the inner world of the patient so that the focus on pain looses it's edge. "Discovering one's own melody, rhythm, tempo and dynamics" raises the patients competence level in all the systems that surround him, which in turn, significantly improves his quality of life.

I. Stojković: Music application in the emergency care Use of music begun in earliest history of mankind both among uncivilized people and biggest cultures of old ages (Mesapotamy, China, India, Egypt). Role of music included everyday ritulas and big events in this peoples lives like birth of a baby, family events and death. In our time we can analyze scientifically usage of music for therapy purposes. Here we analyze music application in emergency care. Emergency department is difficult to harmonize with the music in a therapeutic sense, but can be generally used as a musical background while driving. Only at the very end of intervention procedure it can be used for its anxiolytic effect.

E. Lecourt: Music therapy in France and abroad, psychotherapeutic aspects The music therapy in France is particulary psychotherapeutic oriented, done by music therapists, psychologies, psychiatrists. The greatest authority in this field – Edith Lecourt explains the newest results in this field being active therapeutically and organizationally in France and abroad.

Lj. Radovančević, V. Lecher-Švarc: Correlation of music therapeutic and psychoanalytic aspects of neurosis treatment In this paper the author is submitting to description, analysis, comments and dispute by meeting music-therapy and psychoanalysis. He stresses the variation of non-hypnotic regression due to the help of the music and rhythm background. Such music is often very closely and very well accepted by customers, and affects anxious elements of personality.

M. Marković: Eastern music as therapy Music therapy is applied in various lands and cultures. The transmitting of other culture’s music for local purposes also can benefit therapy. It has been used for thousands years in healthy or sick clients, so whole philosophical concepts of its application and importance in the function of society were developed. Some oriental philosophical approaches are successfully (with modifications) applied for last ten years in Western civilization, culture, and therapeutic approaches.

K. Bakota, D. Obad, G. Koščec:

Music effect exploring of behavior and creativity in children with special needs SUVAG Polyclinic is the health institution for diagnostics and auditory and speech rehabilitation. Rehabilitation and education attendants are the children diagnosed as children with speech communication disorders mostly caused by impairments of hearing and/or speech. In the SUVAG Polyclinic musical stimulations and body movement stimulations are used in the function of development of all speech components. Musical stimulation procedures which are phylogenetically and ontogenetically closer to a human being than speech itself, stimulate quicker perception, fineness and structuring of speech forms. This paper reveals two more examples of using music in the work with children in the SUVAG Polyclinic. The first is the examination of influence of music on intensity, tempo and intonation of speech, face mimic, gestures, speech rhythm, pause, speech aggression and recognition of real context. The second example is the use of music in teaching art culture where students are stimulated to connect auditory and visual sensations. The goal of this use of music is to stimulate creativity and divergent thinking in students, but, first of all, better and entire perception of the world that surrounds them.

Z. Tomašić Sacral Music and Mental Health Sacral music with spiritual component affects the audience in the church or a concert hall and is especially successful among the performers – singers solving also the potentially psychologic problems (i.e. lonelyness etc.). Group performance, mostly vocal, is the main leitmotif of gathering in choirs, and apart from religious elements embraced by the individual effects of the vocal group therapeutic approaches are very important, especially to reduce isolation and depression, and loneliness of life.

Friday, 26th February 2010 Theme: MEDICAL DISORDERS OF PERFORMING ARTISTS Chairman: L. Krapac

J. Grah: Respiratory system anatomy and physiology in playing brass instruments Regardless of whether it is academic or self-taught musicians who plays brass wind instruments, most of his knowledge of anatomy and physiology of the respiratory system is not in accordance with the importance that it has in everyday playing. Often physically demanding playing of the brass instruments combined with unfamiliarity of the organization of respiration and complex interaction of many muscles involved in breathing leads to undue fatigue, which can ultimately frustrate the quality of performance. Final outcome can be recorded as injuries. The main components of the respiratory system are described with emphasis on the muscles that lift and down the chest, especially those involved in forced respiration what is seen by the musicians blowers. We are simply showing the bronchial tree and present the main features of the lungs. We explain basic physiological characteristics of breathing and respiratory volumes. We stress the importance of knowing the basics of anatomy and physiology of breathing because the brass instrument is just a continuation of the respiratory system that allows the development of air currents, and thus the sound of the instruments.

A. Bonevski, T. Lucijanić: Health of musculo-skeletal system in dancers To maintain the quality of their performance dancers expose their bodies to long lasting and strong influences. As muscles get tired, bones and ligament system take more and more load. Micro traumas occur and by the time they accumulate and break the bone. Dancers usually feels the pain in affected area that aggravates by performing special moves. We analyze the body parts that usually get hurt (long bones, spine, lumbo-sacral joints, hips, knees, ankles, feet, fingers, ligaments…). We present early signs and symptoms and recommendations for primary, secondary and tertiary prevention.

A. Bonevski, T. Lucijanić: Lifestyle of professional dancers Lifestyle and personal habits present themselves directly and indirectly on musculo-skeletal system of professional dancer. We consider Feeding disorders (fatness, anorexia and bulimia), drug addiction, anxiety and depression, performing anxiety… Due to the specific nature of their needs, a need to develop holistic and individualised approaches to medical-psychological treatment of dancers is emphasised. Problems are particularly present in distal joints and connective-muscular system of dancers, especially in the ankle and foot. Somatic and especially psychological aspects need to be addressed.

A. Šeketa-Gleich:

Personality of ballet artists Ballet is one of the most difficult performing arts. Ballet, in its act of expressing through dance, creates a piece of art by connecting music, movement, acting, mime and pantomime with the background of a dramaturgic plot. The body of every individual, every dancer is the primary means of expression in ballet. Movements of a body, which are in the function of dance, are a big physical and psychological effort due to high criteria of the ballet art. The beginning of a dance career is the crucial and the most important moment, because at that very moment is determined the future of a child as a future dancer. Because of that the cooperation with the doctors is very important since they would carry out a complete medical examination before the beginning of a dance career. The art of ballet is an everyday art full of exhausting drill in which the wish for dance and determination are above the physical possibilities of a dancer. Only the most determined dancers succeed in ballet. Human body changes a lot and that is the reason why ballet is the art of young people. This is the most intensive but also the shortest art. The biggest award as well as the best inspiration for further work is to dance in front of the audience and to get an applause for it. The feeling of fulfilment and happiness after each successful show is the main moving force of every dancer. Despite all the years and hours of exercising, pain and injuries, dilemmas and starvation, I believe there is no dancer in the world who would give up that feeling and moment on the stage as well as the applause of the audience which already tomorrow is going to be given to someone else.

Mi. Bergovec, A. Popović, T. Lucijanić: Zagreb Musicians’ health Centre We present here historical development of Zagreb Musician’s health centre and way it works. Purpose of this centre is to help artists and their special health problems that result from their way of living and working. It was founded in 1997. at University hospital Dubrava. There is constant need for multidisciplinary approach to professional health problems that can be solved only in a hospital environment. Development of this centre to national level is considered.

M. Lucijanić, D. Breitenfeld: Health of performing musicians There is a great need for appropriate health care for performing musicians that would consider their special living and working conditions and circumstances. Special instruments stress special parts of body more. By neglecting first signs, potential injury becomes more serious. By introducing risk factors for injury and bringing them to the conscious level we can prevent and treat some potentially dangerous injuries. Consequences of injury can be “fatal” for musicians career. During last 50 years small group of physicians and music lovers is gathered around male singing choir “Zagrebački liječnici pjevači”. And is actively working on development of this part of medicine. Since 1997. there is Musician’s health centre working in University hospital Dubrava in Zagreb.

T. Novosel-Weitzer, D. Breitenfeld: Musicians Performers’ medicine a hundred years ago One to two centuries ago the developing of medicine developed also the care for working people (Ramazzini) – for us of special interest stressed on phonation – vocal problems. Here came the help from Italian singer Garcia who invented the laryngoscopic mirror and enabled the laryngoscopy. The care for disease of performing artists developed more and more in last 100 years. Very interesting were the publications of Singer and Flesch. The book of last one is here particulary analysed, especially with comparation with modern books of Hanson, Satalof and Tubiana.

Mi. Bergovec, D. Lucijanić, T. Lucijanić, J. Miletić: Analysis of high intrathoracal pressure Great number of different diseases are direct consequence of high intrathoracal pressure. Wind instrumentalist (brass and wood instruments) are at special risk. To create a sound, performer must create very high intrathoracal pressure that is transferred to all body structures. Lungs and cardiovascular system are specially stressed. Pressure is transferred to cranial and abdominal cavity and can damage body tissues there too and impair normal functions. Smoking has a very negative impact on already damaged respiratory and cardiovascular system.

R. Granić, D. Breitenfeld, D. Buljan, F. Grubišić: Stress and development of psychiatric disorders in performing musicians After musculo-skeletal disorders, next most frequent problem group musicains complain about is psychiatric problems. Due to high amount of stress they are exposed to, performing musicians are more prone to develop such a disorder than common population. We stressed different clinical entities like depression, anxiety, afective disorders, somatoforic disorders and shizophreny. Addictive substances and organic diseases of a brain can aggravate this states.

A. Kopić, D. Breitenfeld: Medical conseqences of conductors’ lifestyle Conductor – profession or lifestyle? Not simple answer to this question. Same as diseases which affect the individuals who work in this profession are not simple. There is a long line of diseases which interact and interlace with each other. Life of a conductor is much more complicated than what we can see on a concert. In the background he is a person that orchestrates an ensemble, works with individuals, balances between technical, financial and organizational elements, he is a manager. Beside diseases which are connected to orchestra management – diseases of locomotor system that result with neurogical damage, they are also affected by diseases of modern age primarily related to stressful way of living. Stressful lifestyle and bad habits lead to cardiac (arterial hypertension, IM), metabolic (diabetes type II, hyperlipidemia), neurological (CVI), malignant, mental diseases and addictions at an earlier age. Parts of the diseases are curable and should be treated. Unfortunately, most of the diseases are not completely curable, but on the other side, with the mutual

cooperation of doctors and conductors, the current state can be improved and further damage leading to serious illnesses can be stopped.

J. Meštrović-Štefekov, J. Lesić, D. Perić: Consequences of performing on skin and mucosa Intimate contact with instrument, usually on exposed body parts, leaves consequences on skin and mucosa. Many specific states can be found described in the literature like practicing points on fingers specific to every instrument, string player neck, cello chin, cello breasts, cello knee, guitar nipples, flute chin etc. We analyze irritative, nonallergic, infectious and allergic inflammatory diseases of skin and mucosa. Persistent trauma contributed to everyday stress can be a trigger for other, genetically determined diseases of skin. We stress some of this cases too.

D. Lucijanić, M. Lucijanić, Ma. Bergovec: Surgical approach in treatment of performing musicians Performing musicians are usually candidates for conservative treatment of their injuries that result from overuse of their musculo-skeletal system. But when such treatment can't give results anymore, their physician should consider possibility of surgical treatment. Most common are cases of canalicular syndromes and degenerative diseases of joints and we analyze them in this work along with possible surgical interventions. Operative procedure is quick, painless and effective. It removes long lasting inability to work and enhances life quality. Musician can return to his performing in few weeks compared to possible months or years of conservative treatment. They don’t easily decide to take such a procedure, but sometimes it can be only way of successful treatment.

B. Perić, D. Kust, D. Breitenfeld: Abuse of addictive substances in performers of different music styles We analyze the problem of addictive substances abuse like smoking, alcohol drinking, drugs and different chemical substances in population of performing musicians. Goal of every professional performer is to have a perfect performance which is a source of great mental stress, anxiety and fears. It’s hard to say how much is substance abuse connected to a lifestyle. In general we can say that classic musicians, their education, music and lifestyle are mostly traditional and substance abuse doesn’t differ greatly from rest of population. Performers of modern music styles are more prone to different substance abuse and looser lifestyles. We stress the role of professional approach in prevention and treatment of this states.

D. Kust, D. Breitenfeld, A. Akrap: Effect of competitive environment on personalities of young performers Big physical and emotional stresses, anxiety that develop and long working hours best describe competitive environment. This situations can have long lasting effect on personality of young performer, especially when they occur during most sensitive times of its development (puberty and adolescence). Consequences

can be of psychic nature: fear, anxiety, introvertion, nail biting, hair pulling, escape from home, rage, lieing, sleep disorders, night fears, feeding disorders, shizophreny, suicidal intentions etc. There can also be somatic presentations like hypertyreosis, asthma, gastrointestinal problems…

B. Starc: Vocography and its application in vocal-technical anlysis and diagnosis of the voice Vocographics is a graphic transcription of phonation used in speech and singing. Phonation is described and recorded by means of specific graphic, otherwise possible only orally and in writing. To observe phonation from the vocographic point of view, subjective and objective, as well as virtual and real, need to become united. In this manner, it is possible to a certain degree to describe and visualize phonation- that invisible "material". Vocographics separates phonation into physiological, physical, sound, and psychological elements and puts them into different categories. It offers new possibilities to vocal science, arts, and pedagogy, as well as to interdisciplinary communication. It can also be combined with phonetic transcriptions, such as the International Phonetic Alphabet. By the use of vocographics it is possible: - to show what can be distinguished physiologically and psychologically in phonation - to record easily, transfer and file voice data - to make a protocol of voicing process and results - to analyze vocal technique and voice posture

G. Ivkić, T. Breitenfeld, G. Armano, D. Breitenfeld: Cerebral interpretation of music Music pathway in human body usually begin with stimulating of ear membrane and this impulse is transferred through inner ear and neural pathways to different brain regions to be analyzed. We show known neuro-anatomical pathways of music stimulus and some new views on brain regions that participate in this process. Different sound qualities are being analyzed in different parts of human brain. This phenomena can be studied in persons that suffered previous CVI or had been submitted to neurosurgical operation. Although there were some tries to centralise music functions of the brain, new experiments show how large areas of cerebrum and cerebellum with wide use of associative regions are affected.

D. Breitenfeld, T. Breitenfeld, V. Demarin: Neurokinesiology of playing dexterity We show development of automatic reaction in human brain from evolutional point of view. Plasticity of human brain in early age and deep proprioceptive sense have a significant role in development of playing dexterity. Playing from kindergarten age is premise for best results. Systematc scrining of kindergarten children could allow us early detection of talented individuals who could be directed into development of such talents.

L. Krapac, F. Grubišić, D. Breitenfeld i M. Lucijanić: Overused arms and hands in professional musicians Epidemiologic studies in the world and in our country have indicated that discomfort and/or diseases of the fist in the elderly population are highly represented. Right hand was dominant in 90,8% in a sample of middle aged population in Croatia. In our population 21.8% of women and 13.9% of older men suffer from osteoarthritis of the fists. In addition to this, 6.4% of women and 1.8% of men over 65 suffer from rheumatoid arthritis. Macro-traumas of the hands have often significant implications on the shape and the function of the hand. Micro-traumas such as the repetitive movement of the fingers, as we see in professional musicians and the workers on video terminal can produce morphological changes, so we devoted special attention to the appearance, morphological and functional changes in rheumatological practice. We conducted an active epidemiological examination of the hand function in 160 professional players (PG) of the orchestras in Zagreb and at 55 PG of Philharmioncic orhestra 1978. We took X-rays of their cervical spine and hands. The grip strength was measured by means of the simple dynamometer according to Martin. Professional string players had left hand stronger than right - as a consequence of the playing technique. Among professional string players, 81% of the examinees have had ulnar deviation of distal interphalangeal joint (DIP) of the fingers of the right hand and 88% of the string players had this change in the left hand. Morphological changes are mostly frequent in the 3rd finger. In the comparative groups of carpenters only 13% of them have had this deviation (P < 0.1). In the praecentral gyrus of the brain area for the hand is very big field. Is that coincidence? The functional potential of the hands is not adequately realizable yet. The question is how an overuse of the hand fingers in playing instruments, and in modern technology will reflect on the morphological changes and function of the hand of the young who too often unphysiologically overuse this part of the body. We proposed preventive measures for relaxing of overused muscles and other parts of the hand.

D. Kristović, L. Krapac, D. Breitenfeld, A. Delija, A. Kopić, D. Juran: Consequences of keyboard playing We present some differences in performing on different keyboard instruments (piano, cembalo, organs, synthesizer, harmonics) and usual health problems that result from it. We debate about injury risk factors with special emphasis on pianists and their playing technique. They are prone to „overplay” their hands and amount of affected musicians sometimes reach 50%. Some specific elements are common find in this group, especially in a hand position while playing.

L. Krapac, M. Škrgatić i Z. Kalafaić: Morphologic changes of cervical spine in «homo sedens» Cervical spine of „Homo sedens“ is often the cause of somatization complains in neurological and mental disease patients (fatigue, vertigo, pain, disease,

invalidity). Morphological changes in the cervical spine can significantly influence the circulation, innervation, swallowing and respiration. Can computer-aided identification and quantification of morphological changes of spine improve recognition rate of chronic diseases of „Homo sedens“? We compare the x-rays of cervical spine (CS) of professional musicians (PM n=55) and professional drivers (PD n=27). Both professions perform their work dominantly in sitting position. Comparative group (CG), equalized by age and sex, was comprised of carpenters and medical workers whose work is performed mainly in standing position. The curvature of cervical spine is quantified from the lateral x-ray of cervical spine by semiautomatic computer tool. Given digitalized x-ray, a tool estimates the curvature of the spine by calculating the curvature of the spine that is fitted to hand-labeled marker points on cervical vertebrae tips. We quantify the shape changes due to lordosis of CS. The developed software tool estimates the model of cervical spine (C1-C7) from the image and overlays it over the x-ray image. The user can change the model by changing the positions of vertebrae tips. From the final model we calculate several measures of curvature of CS. Hipolordosis and alordosis of cervical spine are significantly more encountered in the string instruments PMs (50% : 12,3%) than on the x- rays of carpenters (24,1%) and alordosisis of CS in medical workers (24,1%) (p< 0,01) 1. The curvature estimation of the CS (clinical and radiological) performed so far was subjective, without standardized parameters. 2. Ever growing incidence of complains and/or diseases of the CS requires more precise morphological and radiological quantification. 3. A large number of standard x-ray pictures is possible to process fast by quantitative computer analysis with acceptable (economical) costs. 4. This approach enables an unbiased quantification of morphological changes and a comparison with neurological (TCD) and other clinical diagnostic methods that measure the changes of the bone and the vascular structure of the CS.

F. Grubišić, L. Krapac: Physiatric problems of the musculoskeletal system in performing musicians Musculoskeletal disturbances in performing musicians are frequent on all levels of performing, and in all age groups as well. Occasional slight pain during rehearsals or performances is common, because the musculoskeletal system is under greater strain. If discovered early, musculoskeletal disturbances can be reduced significantly, and in that way the risk of poor performance is reduced as well. The presentation deals with epidemiological data on musculoskeletal disturbances, their localizations, mechanism of injury and symptoms caused by playing musical instruments. The most common musculoskeletal disorders are: overuse injuries of shoulder, elbow, wrist and hand, fibromyalgia, degenerative diseases of the musculoskeletal canalicular syndromes.

L. Krapac, A. Delija, D. Breitenfeld, Ma. Bergovec: Working chair of professional musicians Low back pain (LBP) especially on workers in sitting position is big public health problem. As a medical problem of musculoskeletal system (MSS) professional musicians (PM) often declare LBP and at work they use inadequate working chairs. Is in that fact causal connection? By a standardized anamnesis and clinical examination we include in researc 260 PM from Zagreb Philharmonic orchestra, orchestras from Croatian national theatre in Zagreb, Split and Rijeka and Zagreb theatre orchestra from “Komedija”. In Zagreb, Split and Rijeka we photographed chairs and characteristic working positions posture in sitting and holding their instruments. In all of this orchestras male (65.2%) were predominant. Average age was 62.7±12.5 years and average of their engagement in playing instruments, including a primary, secondary and high school education was 30.2±10.8 years. Most frequent disease of MMS was LBP (mild 19%, medium 10% and severe 3%). Without LBP was only 20% PM. During the playing pain emerges in 40% PM, during exertion of partitures 24%. Other pain as morning pain, pain at rest or permanent LBP have rest of 16% PM. Photographs of working chairs of violinist, cello list and contrabassist are compared wit working chairs of other PM. We are looking for connections of working conditions of PM with possible development and/or worse of LBP. 1. Females PM especially in middle age but also PM on string instruments are vulnerable group in pathology of lumbar spine. 2. In the young group of PM we proposed primary prevented measures and at older PM the measures of secondary or tertiary preventions LBP-particularly potentially by work and long travel. 3. We proposed ergonomic measures as the way of improving at work on string instruments. 4. We are going to continue monitoring of health conditions on PM by multicentric and interdisciplinary approach of this health problem not only in professional musicians, but also in ergonomic rules of work at computer workers. They are also in preadolescent age exposed unphisiologicaly, forced body posture at work.

D. Srdoč: Diagnostic approaches in overuse syndromes More common health problems of performing musicians and diagnostic approaches are presented in this work. Special emphasis is put on visual imaging by different techniques (ultrasound, RTG, CT, MRI), their pro and contras. The goal is to observe professional risk factors and then decide which radiologic protocol is adequate to gather relevant data to treat a patient in time and with good results. MRI as up-to-date method is still very expensive, but it is a method of choice in imaging of soft tissues that are often affected in prefossenioal musicians.

S. Rucner:

Mental health and musicians’ disorders Music has always been present in everyday life. Nothing else could produce so many powerful emotions at the same time - happiness, love, sorrow, enthusiasm… Music and rhythm are natural part of every being. Unfortunately due to numerous external factors music performers are very often exposed to various disbalances and even illnesses. Therefore prevention and education play a very important role for musicians – this is why musical therapy is of such importance.

M. Lucijanić, T. Breitenfeld, G. Ivkić, J. Miletić: Common canalicular syndromes in performing musicians Playing with inappropriate technique and without appropriate pauses is very common among performing musicians. Canalicular syndromes are direct consequence of such body “maluse”. We describe anatomy of peripheral nervous system and it’s weak points (while crossing joints and musculo-tendinous departments) and pathophysiology of canalicular syndrome development. We describe most common clinical syndromes and presented possibilities of conservative and surgical treatment.

M. Vodanović, V. Hutterer, Ž. Jurašinović: String players’ diseases Professional diseases of string instrumentalists are mostly the consequence of inadequate technique (overuse syndromes). Dermatologic conditions are also common. We describe different kind of instruments and their effect on musculoskeletal system of performer (violin, viola, cello, contrabass) and give some recommendations for prevention.

E. Lecourt, D. Kust, D. Breitenfeld, A. Kopić, M. Prstačić: Medicine and music in France, performing musicians, etc. Performing musicians medicine is Europe developed in few last decades in highly professional manner. In France is R. Tubiana especially great authority in general and surgical interventions for performing musicians. The situation is compared with other fields.

M. Lucijanić, L. Krapac, D. Breitenfeld, J. Miletić: When does an overuse injury occur and how to manage it? Prevention of musculoskeletal injuries is most effective if we start it from earliest age and musician-instrument contact. We reduce the chance of injury to happen with correct technique of playing, sitting, carrying and acquiring correct habits of warming up, stretching and relaxing. All risk factors cannot be avoided, especially in situations of lack of time (before big performances, competitions etc). When injury happens, change of habits and physiatric methods (RICE) have a primary role in treatment. We describe special risk situations and possibilities of conservative treatment.

L. Bergovec, M. Kereković, D. Breitenfeld:

Singers’ «lost» voice Just like other body parts, vocal cords and associated musculature can be damaged by constant usage without appropriate pauses. Overuse syndrome of vocal cords is called phonastenia or “lost” voice (silent, broken voice). It’s mostly the result of bad singing technique. We describe some states that usually disable normal phonation and basic diagnostic and therapeutic measures in such cases of phonastenia.

M. Mlinac-Lucijanić, T. Lucijanić, B. Perić, D. Lucijanić: Doctor’s responsibility Hands of a pianist, voice in a singer or feet in a ballet dancer are the most important instruments and by their injury, performer becomes existentially endangered. Inappropriate, uncaring or not treatment of injury leaves a great damage to performers live and career. Damaged side can sue his physician and ask for a compensation. Juridical aspect of patient-doctor relationship also includes the question of professional secret and health certificates. We present this always actual and very sensitive field from the view of doctors responsibility and compensation claims.

T. Barčan, M. Šubarić, Ž. Jurašinović: Hearing problems in performing musicians In this article we present hearing problems in performing musicians. They are frequent among popular music performers due to strong sound amplifiers. In brass players we also find higher share of hearing disorders and we present here some personal experiences with hearing damage in brass players, especially active in millitary orchestras. Some protection methods and protective gear are recommended.

Saturday, 27th February 2010 Theme: DESTINIES AND DISEASES OF COMPOSERS Chairman: T. Breitenfeld

B. Perić, D. Kristović, A. Kođić, L. Bergovec, Ma. Bergovec, D. Breitenfeld: Destinies of composers - pianists Bartolomeo Cristofori di Francesco, Italian maker of music instruments, is considered as piano inventor. There will be few words about some famous and less famous composers, who enhanced the world music heritage with their pieces. Wolfgang Amadeus Mozart, one of the most briliant composers ever, beside his creativity talent, had a lot of healthy problems. Ludwig van Beethoven's hearing began to deteriorate with progression to complete deafness. Many composers and pianist left their work more or less unfinished due to disease and death. Nevertheless it is a great contribution of composers and pianists to the music art and the art in general.

D. Lucijanić, D. Breitenfeld, Š. Ozimec-Vulinec, M. Župančić, Z. Stahuljak: Diseases of musicians’ family Stahuljak This important musicians family originate from amateur musician ancestor. They were later rugulary schooled and created significant number of musicians. It was one of the greatest musicians family in the world like Bachs etc. Mayority of them lived quiet and successful long life and ended dieing from old age. Individuals died from vascular problems of the old age, sometimes they died in accidents and other emergency medical conditions. Stress caused by war tragedies had it’s role in ailing and death.

D. Lucijanić, D. Perić, S. Vukovojac, D. Breitenfeld, D. Juran: Diseases of musicians’ family Dugan In this report are stressed patographic data of family with many composers and musicians. They all came from the most famous person in the family, the composer Franjo Dugan the older. Some of them died as mentioned composer of cancer. Other died from CVI or much earlier from melanoma.

T. Barčan, M. Šubarić, D. Lucijanić, G. Babić, D. Breitenfeld: Deafness in composers Some famous composers had hearing loss up to the deafness what incapatieted them very much in their composing and carrier. Beethoven diagnosis was probably otosclerosis or acoustic nerve inflammation. Smetana and Spontini had complete luetic deafness. Franz had probably otosclerosis, Faure had a sort of cohlear pathology. Krežma died probably at age of 19 of otogenic meningitis. Presbiacusis was the probable diagnosis of Vaughan Williams, Harrison, Spohr, Schuetz, Rousseau, Klenau and Franz.

L. Bergovec, G. Rujevčan, Mi. Bergovec, D. Breitenfeld, I. Prošev, D. Feletar: Diseases of Međimurje composers

There were only a few important Croatian composers in the last two decades. They were born in Međimurje and often worked in other countries due to their education. The most important among them is Josip Štolcer Slavenski (1896- 1955), who had great international success. After some digestive problems, a liver carcinoma was found through an operation- that was the cause of his death. Fortunat Pintarić (1798- 1867), Vinko Žganec (1890-1976) and Miroslav Magdalenić (1906- 1967) are also stressed.

D. Breitenfeld, A. Kopić: Destinies, diseases and creativity of lawyers composers Many musicians and composers paralely studied for other vocations at the beginig of their career. They often studied law school like all Bach's known sons did. Other known names are: E. C. A. Hoffmann. We stress Chabrier who devoted first half of his career to law vocation. Tschaikovsky finished law school, although he didn't work as lawyer. In Croatia is known case of Lisinski who finished his law school and tried to affirmate as a composer. In lack of posibility for musical work, he returned to his law vocation and died as a poor of tuberculosis. Today in Croatia there are Josipović and other prominent composers.

D. Breitenfeld, J. Korpar, I. Špralja, M. Mlinac-Lucijanić, D. Juran: Croatian composers executed in World war II Violent deaths of croatian composers are being presented in this article. In the report are stressed in brief the violent deaths of executed croatian composers about the World War II. Some of them are previously described in detail (B. Polić). Very few of cases can be connected with understandable revenge. Most deaths were result of terror and terrorism of that time.

P. Kornhauser: Sexual deviation of Tschaikovsky Tschaikovsky had a broken relationship with his early died mother. Early he went to a military and juridical school. There he went under homo-erotic influences, was presumably sexualy abused by older schoolars. He developed into a gay person with relationships in his own family and after with younger and younger boys. His marriage was a mistake and a formal situation. With time he was less neurotis and drank less because of hiding his gay orientation. But with his homo- erotic scandal in higher aristocratic circles he was very seriously acoused and he decided to committ suocide with arsen. The medical help and interventions are analyzed.

M. Lucijanić, D. Breitenfeld, M. Mlinac-Lucijanić, E. Galinska, W. Szulc: Diseases of Polish composers A vast nuber of significant composers marked Polish culture and history, starting from most important Frederic Chopin who was of French origin, but totaly incorporated in spirit and creation of Polish music, over Stanislaw Moniuszko, creator of first Polish opera, and Karol Szymanowski who represented modern

musical heritage. Croatian readership may be especially interested in life of Ludomir Rogowski who spent last years of his life in Croatia. In the spirit of up-to- date medical data we are today able to consider circumstances about their lives, diseases and deaths from views other that officially accepted. We present many other composers partly chronologically and partly by their significance.

S. Poch-Blasco, M. Lucijanić, D. Breitenfeld: Diseases of Spanish composers Respect for Spanish music is older than middle ages or renessance. Although there is not much data about life and health of famous composers of that time, we tried to collect and present some of the most important and interesting life stories. During last century, there have been many new composers which contribution to world music heritage is unmeasurable, so we present those in more detail (Pedrell, Albeniz – died from uremic toxicity in early middle ages, Granados y Campina – died from drowning during WWI, de Falla – during gut penetration sudden heart death occurred, etc).

C. Ravenna, G. Cremaschi, T. Breitenfeld: Diseases of Italian composers Among many significant Italian composers we decided to put special accent on Palestrina who died during plague season because if pulmonary problems in malary areas of Roman Empire, Vivaldi who died suddenly in Vienna from chronic asthmatic problems, Rossini who died from heart decompensation during purulent neoplastic rectal process, Bellini who died from amoebic disenteria, Donizetti who died in last stage of progressive paralysis and tabes dorsalis, Pucini died during surgical procedure of larynx carcinoma etc.

T. Novosel-Weitzer, D. Breitenfeld: Diseases of Austrian composers More than a hundred of Austrian musicians are mentioned, but more in detail are presented diagnoses of Mozart who died from acute reumatic fever, J. Haydn who died from cardiocerebral vascular problems due to old age, Bruckner who also died in old age from cardiovascular disorders, Wolf who died from pneumonia during progressive pralysis caused by syfilis, Mahler who died from strptococcal endocarditis etc. We have a special interest in J. Haydn for his possible Croatian origin.

D. Breitenfeld, D. Kust: Diseases of German Composers In the report are stressed patographic data of about hundred german composers. Some are onlya mentioned and more in detail are mentioned some most famous composers as were Bachs who almost all died from some kind of acute pulmonary process combined with delirium, stroke, tuberculosis etc., Haendel who died blind in his old age, Beethowen who died from pneumonia, Brahms who died from billiary pancreatic carcinoma, etc.

J. Čić, D. Breitenfeld, D. Kust: Haydn, Liszt – Burgenland composers Haydn and Listz were composers from Burglenland near Wienna, in a teritory with mixed Croatian, Austrian and Hungarian population. Liszt's nationality was mostly Hungarian and J. and M. Haydn's was unclear by both parental sides. (Koller-Kolar, Haydn – Hajdin). The name Hajdin is comon in Gradišće and Croatia. Both of them died in their old age from vascular and delirant health problems.

D. Breitenfeld, M. Lucijanić, D. Kust: 2010. Jubilareans: Schumann, Chopin, Mahler, Pergolesi and Wolf We celebrate anniversaries of these famous composers in this few years so we put a special stress on Schumann who sufferd from complex combination of shizo-affective disorder, alcoholism and progressive paralysis, Chopin – most probably tuberculosis, Mahler who died from streptococcal endocarditis, Pergolesi who died early from pulmonary tuberculosis and Wolf – progressive paralysis; and their life and work.

V. Demarin, S. Antić: Music as stimulus in patients with stroke Auditory stimulation increases mean blood flow velocities (MBFV) in the middle cerebral artery (MCA) in healthy individuals. Our goal was to monitor these changes in the affected MCA in patients with acute ischemic stroke (AIS). In our study 74 patients were included with AIS that were nontrombosed who were divided into two groups based on their NIHSS (National Institutes of Health Stroke Scale) score. In the affected MCA we followed MBFV with transcranial color Doppler (TCD). Group I consisted of patients with NIHSS score <10, group II had an NIHSS score> 11th We measured MBFV MCA during the cases during music sessions for 30 minutes. We measured the time (Tmax) and percentage changes in amplitude (Amax) of the first maximum response MBFV ACM. For statistical analysis we used Pearson Chi-Square test. In 78.85% of patients, we noticed a statistically significant increase in MBFV compared with basic values. A statistically significant difference was found in reaction time (Tmax) between the two groups, but not in amplitude response. He also found a statistically significant difference in NIHSS score between the first and seventh day of hospitalization. Our study has shown that music acts as an auditory stimulation in patients with stroke, which can be measured by TCD as the increase MBFV ACM. By increasing the flow through the MCA music leads to a better blood supply of the brain after stroke and contribute to rehabilitation and recovery of patients.

E. Lecourt, D. Kust, D. Breitenfeld, M. Prstačić: Diseases of French composers Among great number of French composers, we put special stress on Lully – post traumatic gangrena, Berlioz – opium addiction combined with strokes, Chopin – most probably pulmonary tuberculosis, Bizet – suddent heart death with reumathic streptococcal changes, Debussy – rectal neoplastic disease and

Rousseau – probably urologic prob. Others like Barraqué, Poul, Boulanger, Honegger – pulmonary embolus, Dupont - tuberculosis, Ibert, Ravel – cerebral atrophy, Roussel – sudden heart death, Koechlin, Dukas – sudden heart death, Chausson – traffic accident, d'Indy, Duparc, Fauré, Massenet, Chabrier – progressive syphylitic paralysis, Delibes – sudden vascular death, Couperin are mentioned.

M. Vodanović, D. Breitenfeld, O. Skille: Diseases of Scandinavian composers Gade, Svendsen, Grieg, Sinding and Nielsen are most significant Scandinavian composers and they all died from problems caused by cardiovascular etiology. Grieg also suffered from chronic tuberculosis. They had a prominent role in historic development of world music, but also the culture of their own nations. The youngest among them in the moment of death was Grieg. He died as a result of long and heavy illness. Other died from sudden deaths with advanced cardiovascular and cerebral backgrounds.

Y. Schiftan , M. Lucijanić, J. Miletić, M. Turina, D. Breitenfeld, V. Vrbanić: Diseases of Swiss composers Switzerland could be considered small country for her size and number of inhabitants, but some very important and worldwide known composers originated from her. Most known are Honegger who died from pulmonary embolus, Bloch – neoplastic disease, Martin – also neoplastic disease, Sutermeister and Lienerman who both died from vascular health problems in their old age. We analyzed their lives, diseases and destinies in this work. There is a need for new researches.

A. Fenwick, M. Lucijanić, J. Miletić, D. Breitenfeld: Diseases of British composers During her long history Great Britain gave many famous composing names. Their contribution to world music heritage is unmeasurable. We put special emphasis on Britten – died from brain complications after heart surgery, Byrd, Lawes, Purcell – pulmonary tuberculosis, Delius – tabes dorsalis, Vaughan – sudden death in his older age. We also studied other less known composers. In this work we mention Elgar, Delius, Bliss, Arnold, Bax, Holst, Tippett, Walton, Ireland, Tallis, Moeran, Bernard, Sullivan and Arne. Composers lived relatively long due to character of their work and need for peaceful lifestyle for long hours of composing and practicing.

I. Fattorini, D. Janigro, M. Lucijanić, M. Vodanović, D. Breitenfeld: Diseases of American composers USA, as a relatively young nation contributed significantly to world music by great number of famous composers and we can freely call them great composing country. Many composers of different nations gravitated to USA for good living and working conditions, possibilities to develop and perfect their skills so they became americanised. Sousa – died from stroke, MacDowell – progressive

paralysis, Parker, Ives - strokes, Copland, Gershwin – brain neoplastic process, are only some of many significant names. We mention Riegger, Berlin, Antheil, Blitzstein, Barber and others.

T. Breitenfeld, V. Demarin, D. Breitenfeld: Stroke in baroque composers The period of baroque in art and music lasted from 1600.-1750.a.d. This period included Italian composers like Vivaldi, Corelli etc. as well Schuetzs, Bachs, Haendel etc. The last ones died of stroke, besides great number of mentioned less famous composers. Average lifetime of composers was relatively long, so many of them died of stroke, disease of older population.

T. Breitenfeld: Creativity and brain Cretivity is bound neurolgicaly to the whole brain beinf fixed also to some regions of perisylvian, frontal, temporal, insular and parietal gyri as well with some intercallosal connections, amygdal nuclei, region of lymbic system and parts of cerebellum. Neuropsychologically and psychosocially was the creativity analysed too. There are some special interesting cases as was Ravel who died from brain atrophy, Gershwin – died from brain malignoma and especially the cases of Dvoržak – uremia and intracranial haemorraghe and Prokofiev – intracranial haemorraghe.

P.Kornhauser, Z. Slavec-Županič, V. Celarec, S. Pettan, D. Kust, D. Breitenfeld: Disease in Slovene composers We collected data about Slovene composers from family, medical and church sources. We put special stress on Gustav Ipavec, Gojmir Krek, Josip Ipavec, Marij Kogoj and Rado Simoniti. Large amount of composers lived up to old age, part of them died of typical internal pathology of last centuries and some died of tuberculosis, very young.

I. Stojković, M. Marković, D. Breitenfeld: Diseases of Serbian composers Serbian composers except some who died early from tuberculosis (K. Stanković) and some of them falling in the war (Vasiljević etc.) mostly of them lived long successful life without great diseases. S. Mokranjac (Stojanović) was renally ill, escaped the Austrian troops in World War I, emigrated to Skopje and died quite suddenly. The further investigation is planned.

J. Miletić, M. Lucijanić, M. Mlinac-Lucijanić, D. Breitenfeld: Famous composers of «small nations» (Enescu, Sibelius, Villa-Lobos and others) Althoug some nations are not considered great by their size or number of inhabitants, in the sense of famous composers they definitely are. Composers from these countries influenced the development of national and world cultural

heritage. We mention composers from Japan, Canada, Argentina, Mexico, Brazil, Peru, Australia, Israel, Malta, Island, Finland, Turkey, Greece, Romania, Bulgaria, Macedonia, BIH, Montenegro, Netherlands, Belgium, Slovakia, Ukraine, Belarus, Georgia, Armenia and other countries. Depending of their home countries and countries where they lived, they practiced different living and working conditions, wars and migrations that reflected on their longevity.

J. Blaić, I. Blaić-Dediol, D. Breitenfeld, D. Lucijanić: Early death of Dora Pejačević Dora Pejačević was an eminent female composer of Croatian aristocratic origin. She had many friends in the intelectual elite of Europe. Her music was also very appreciated in whole middle Europe. She lived modern lifestyle, but when she felt the need for her own family and children she married a younger man. Being of gracile stature she was afraid of the delivery. It went without complications, but after some days she developed puerperal sepsis. She was hospitalized in in Munich obstetric house where she fought her life battle within preantibiotic era. After worsening of symptomes and renal lesions she became comatous and died.

T. Breitenfeld, V. Demarin, D. Breitenfeld, D. Buljan: Neurologic and psychiatric diseases of composers There were anlysed 400 composers, about 200 as comparative group and group of 101 stroke, 82 alcoholics and drug abusers as well some dozens of neurosyphilitcs, other neurologic patients – diagnoses and psychoses and suicides. Longest lived the composers died of stroke, nearly to the comparative group and especially low life expectancy rate was found in suicides, alcoholics, neurosypchiltics and other psychoses. The dignoses were properly defined, within last 1 – 2 centuries. In the last period of medicine development were the therapeutic possibilities much greater and so the famous composers could be much more cured, their creativity prolonged although they could be in another danger i.e. of acute cardiovascular diseases.

J. Gjurović, D. Kust, D. Breitenfeld, Lj. Bjelinski: Diseases of Bruno Bjelinski Bruno Bjelinski was life friendly, vital, longliving person, extroverted to the last moment of his life. He wasn't ill until last 10 years of his life, then he suffered his first myocardial infarction which he tried and succeeded to rehabilitate himself in a great manner. Some years later he had a minor new myocardial infarctoin, but the most severe one was the prelethal infarction, all hospitally carefully treated. His rehabilitation was less successful, he went to vacancies, felt mediocre and finally during friendly discussion abruptly succumbed to disease without pain.