“Neuro‐Q no.1 = Neuro‐Quran”

27 July 2010School of Medical Sciences

USM Health Campus

Dr.Muzaimi MustaphaDepartment of NeurosciencesSchool of Medical Sciences

TRANSDISCIPLINARY RESEARCH SEMINARCLINICAL SCIENCE RESEARCH PLATFORM

Stroke Burden

Leading morbidity

Significant mortality

Economically costly

Treatable

Preventable

Stroke Heterogeneity

Ischaemic stroke (80%)Hemorrhagic stroke (20%)

• Cardio‐embolism (20%)

• Lacunar (small vessel) disease (25%)

• Cryptogenic (5%)

• Intracerebral hemorrhage (80%)

• Subarachnoid haemorrhage (20%)

• Atherothromboembolic(large vessel) disease (50%)

• Clinical Practice Guideline (CPG): Management of Stroke 2008

1. Imaging

2. Hyperacute/Acute management

3. Stroke rehabilitation

4. Stroke prevention

Stroke Management

• National Institute of Health (NIH), Ministry of Health: Stroke as health 

research priority in the 9th

Malaysia Plan 2006‐2010  (Needs Analysis)

Outlined in the Malaysian:

Evidence‐based medicine

Key impairments:motor function

language cognition

sensory processingemotion

Music Therapy For Acquired Brain Injury

• 7 trials (184 participants). 4 on stroke, 3 use RAS.

• Rhythmic auditory stimulation (RAS) appears beneficial for improving gait parameters in stroke patients, including gait velocity, cadence, stride length and gait symmetry.

• Results encouraging, but more RCTs needed.

• More research is needed to examine the effects of sound therapy on other outcomes for routine use in clinical practice.

http://www.colostate.edu/

RAS: Center for Biomedical Research in Music (CBRM)

Robert F.UnkeferAcademy of Neurologic

Music Therapy

Neuroscience ResearchLaboratories

Neurologic MusicTherapy Clinics

(OutReach)

College of Liberal Arts Cellular and Integrative Neuroscience Program

Department of Electrical Engineering Biomedical Engineering Program

Regional Hospitals

AFFILIATIONS

CBRM

Music Therapy And Medicine

Rhythmic Auditory Stimulation (RAS)

Patterned Sensory Enhancement (PSE)

Therapeutic Instrumental Music Playing (TIMP)

Speech StimulationMelodic Intonation Therapy (MIT)

Rhythmic Speech Cuing (RSC)Vocal Intonation Therapy (VIT)

Therapeutic Singing (TS)

Oral Motor and Respiratory Exercises (OMREX)

Thaut (1999) Training Manual for Neurologic Music Therapy. CBRM: Colorado State University

Stroke rehabilitation Key impairments:motor function

language cognition

sensory processingemotion

“If You Couldn’t Find It, There’s Business”

Working Mechanisms: Rhythm and The Brain

“Rhythmic entrainment occurs through direct projection to the motor system, beginning with the encoding of information in the auditory system.”

“Information transfers directly to motor areas or that the auditory cortex contributes to entrainment via common thalamic projections shared with cortical motor areas.”

LaGasse et al 2009

“Spiritual Rhythm”

and The Brain• Western sciences have converged on naturalistic explanations of the world:

physics, biology, neuroscience, etc.• Casts doubt on supernatural realities.• Science and religion or spirituality do not mix.Evidence‐based medicine: Psychological therapies

‐

Behaviour Therapy

‐

Cognitive Therapy

‐

Cognitive Behaviour Therapy (CBT)

‐

Dialectical Behaviour Therapy (DBT)

‐

Interpersonal Psychotherapy (IPT)

‐

Mindfulness‐Based CBT

‐

Acceptance and Commitment Therapy

Aimed at symptom reduction – deal with thoughts, feelings behaviour, relationships, etc.Acknowledge that human beings have metacognitive awareness – like to contemplate, ponder, reflect on their experiences and the world around them

• Early Muslim scholars described and taught cognitive behavioural models and methods: exposure, cognitive restructuring, behaviour change (Ibn al Qayyim; Al Ghazali)• Islamic teachings / practices embody potent cognitive & behavioural prescriptions: decreases physiological arousal (anxiety) and enhances emotional functioning (mood control).

“Spiritual Rhythm”

Islamic Concept of Self:  “Metacognitive Awareness”

• Aql (intellect, rational/reasoning  mind)

• Qalb

(spiritual heart, seat of  knowledge, intention, belief,  justice) 

• Nafs

(ego, feelings, desires,  negative thoughts)

• Ruh

(the spirit, the true human,  the one in charge, live on after 

physical death) 

“Spiritual Rhythm”

and The Brain

“(and) when My servants ask of Me, I am truly near (them): I head

the call of every 

caller when he calls on Me. Let them also, with a will, listen to My call, and believe 

in Me: That they may walk in the right way.”

(2:186)

In the Name of Allah, Most Gracious, Most Merciful

“Spiritual Rhythm”: The Holy Quran

In Summary: “Neuro‐Quran”

Leading morbidity

Significant mortality

Economically costly

Treatable

Preventable

Stroke rehabilitation

Music TherapyEvidence‐based medicine

RAS, PSE, TIMP, MIT, VIT, OMREX, etc

Physical & Psychological

“Spiritual Rhythm”

“Neuro‐Quran”