it more beneficial than instrumental music. promotion of healthy sucking reflex: by using a pacifier-activated lullaby device, music therapists can help promote stronger sucking reflexes, while also reducing pain perception for the infant. the gato box is a small rectangular instrument that stimulates a prenatal heartbeat sound in a soft and rhythmic manner that has also been effective in aiding sucking behaviors. the music therapist uses their fingers to tap on the drum, rather than using a mallet. the rhythm supports movement when feeding and promotes healthy sucking patterns. by improving sucking patterns, babies are able to coordinate the important dual mechanisms of breathing, sucking and swallowing needed to feed, thus promoting growth and weight gain. when this treatment proves effective, infants are able to leave the hospital earlier. multimodal stimulation and music: by combining music, such as lullabies and multi-modal stimulation, premature infants were discharged from the nicu sooner than those infants who did not receive therapy. multi-modal stimulation (mms) includes the applications of auditory, tactile, vestibular, and visual stimulation that helps aid in premature infant development. the combination of music and mms helps premature infants sleep and conserve vital energy required to gain weight more rapidly. studies have shown that girls respond more positively than boys during multimodal stimulation. while the voice is a popular choice for parents looking to bond with their premature infants, other effective instruments include the remo ocean disk and the gato box. both are used to stimulate the sounds of the womb. the remo ocean disk, a round musical instrument that mimics the fluid sounds of the womb, has been shown to benefit decreased heart rate after therapeutic uses, as well as promoting healthy sleep patterns, lower respiratory rates and improve sucking behavior. infant stimulation: this type of intervention uses musical stimulation to compensate for the lack of normal environmental sensory stimulation found in the nicu. the sound environment the nicu provides can be disruptive, but music therapy can mask unwanted auditory stimuli and promote a calm environment that reduces the complications for high-risk or failure-to-thrive infants. parent-infant bonding can also be affected by the noise of the nicu, which in turn can delay the interactions between parents and their premature infants. music therapy creates a relaxing and peaceful environment for parents to speak and spend time with their babies while incubated. parent-infant bonding: therapists work with parents so they may perform infant-directed singing techniques, as well as home care. singing lullabies therapeutically can promote relaxation and decrease heart rate in premature infants. by calming premature babies, it allows for them to preserve their energy, which creates a stable environment for growth. lullabies, such as "twinkle twinkle little star" or other culturally relevant lullabies, have been shown to greatly soothe babies. these techniques can also improve overall sleep quality, calorie intake and feeding behaviors, which aid in development of the baby while they are still in the nicu. singing has also shown greater results in improving oxygen saturation levels for infants while incubated than has mothers' speech alone. this technique promoted high levels of oxygen for longer periods of time. infants in cardiac icus in studies on music therapy with infants in the cardiac intensive care unit, music therapy has been used on infants in hopes of improving their lives during their time in the cicu. many infants show a decrease in both their average heart and respiratory rates. the infants' average blood pressure typically decreases after the music therapy sessions, as well. although there are individual differences between each of the infants, most infants show improvements after music therapy interventions. use with medical disorders music can both motivate and provide a sense of distraction. rhythmic stimuli has been found to help balance training for those with a brain injury. singing is a form of rehabilitation for neurological impairments. neurological impairments following a brain injury can be in the form of apraxia – loss to perform purposeful movements, dysarthria, muscle control disturbances (due to damage of the central nervous system), aphasia (defect in expression causing distorted speech), or language comprehension. singing training has been found to improve lung, speech clarity, and coordination of speech muscles, thus, accelerating rehabilitation of such neurological impairments. for example, melodic intonation therapy is the practice of communicating with others by singing to enhance speech or increase speech production by promoting socialization, and emotional expression. autism music has played an important role in the research of dealing with autism, mainly in diagnosis, therapy, and behavioral abilities according to a scientific article written by thenille braun janzen and michael h. thaut. this article concluded that music can help autistic patients hone their motor and attention skills as well as healthy neurodevelopment of socio-communication and interaction skills. music therapy also resulted in positive improvement in selective attention, speech production, and language processing and acquisition in autistic patients music therapy is thought to be helpful with autistic children by providing repetitive stimuli that aim to "teach" the brain other possible ways to respond that might be more useful as they grow older. studies on the long term effects on music therapy in children with autism indicate many positive effects in children. some of these effects include increased communication skills, decreased stress, increased social interaction, and the ability to be creative and to express themselves. music therapy not only benefits the child with autism, but the family as a whole. many of the mothers of children with autism claim that music therapy sessions have allowed their child to interact more with the family and the world. music therapy is also beneficial in that it gives children an outlet to use outside of the sessions. many children after participating in music therapy want to keep making music long after the sessions end. heart disease according to a 2013 cochrane review, listening to music may improve heart rate, respiratory rate, and blood pressure in those with coronary heart disease (chd). furthermore, research has been done on children with simple congenital heart disease. in a study conducted in fuzhou, china, it was discovered that preoperative music therapy lead to a decrease in anxiety around surgery, reduced the psychological impact on the patient, stabilized vital signs, and improved patient cooperation with anesthesia induction. stroke music is useful in the recovery of motor skills. in a study on stroke patients in the recovery phase, music therapy was used in addition to other types of therapy in one group of patients and was not used in the other group. while both groups showed an increase in their standard of living, the group that used the music therapy showed more of an increase than the group that didn't. the group that used music therapy also showed less anxiousness and depression after the therapy. while both groups showed an increase in the strength of their non-dominant hands, the group with music therapy showed a much larger increase. also, patients that underwent music therapy were able to regulate their emotions better and showed increased communication as a whole. dementia main article: music therapy for alzheimer's disease like many of the other disorders mentioned, some of the most common significant effects of the disorder can be seen in social behaviors, leading to improvements in interaction, conversation, and other such skills. a study of over 330 subjects showed that music therapy produces highly significant improvements in social behaviors, overt behaviors like wandering and restlessness, reductions in agitated behaviors, and improvements to cognitive defects, measured with reality orientation and face recognition tests. the effectiveness of the treatment seems to be strongly dependent on the patient and the quality and length of treatment. a group of adults with dementia participated in group music therapy. in the group, these adults engaged in singing, drumming, improvisation, and movement. each of these activities engaged the adults in different ways. the singing aided with memory, as these adults improved memorization skills in by taking out specific words in the chorus of a song and by repeating phrases back to the music therapist when the therapist sang a phrase of a song to them. drumming led to increased socialization of the group, as it allowed the patients collaborate to create particular rhythms. improvisation allowed the patients to get out of their comfort zone and taught them how to better deal with anxiety. lastly, movement with either one arm or two increased social interaction between the patients. another meta-study examined the proposed neurological mechanisms behind music therapy's effects on these patients. many authors suspect that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. others suggest that music serves as a sort of mediator for social interactions, providing a vessel through which to interact with others without requiring much cognitive load. aphasia broca's aphasia, or non-fluent aphasia, is a language disorder caused by damage to broca's area and surrounding regions in the left frontal lobe. those with non-fluent aphasia are able to understand language fairly well, but they struggle with language production and syntax. main article: music therapy for non-fluent aphasia neurologist oliver sacks, studied neurological oddities in people, trying to understand how the brain works. he concluded that people with some type of frontal lobe damage often "produced not only severe difficulties with expressive language (aphasia) but a strange access of musicality with incessant whistling, singing and a passionate interest in music. for him, this was an example of normally suppressed brain functions being released by damage to others". sacks had a genuine interest in trying to help people affected with neurological disorders and other phenomena associated with music, and how it can provide access to otherwise unreachable emotional states, revivify neurological avenues that have been frozen, evoke memories of earlier, lost events or states of being and attempts to bring those with neurological disorders back to a time when the world was much richer for them. he was a firm believer that music has the power to heal. melodic intonation therapy (mit), developed in 1973 by neurological researchers sparks, helm, and albert, is a method used by music therapists and speech–language pathologists to help people with communication disorders caused by damage to the left hemisphere of the brain by engaging the singing abilities and possibly engaging language-capable regions in the undamaged right hemisphere. while unable to speak fluently, patients with non-fluent aphasia are often able to sing words, phrases, and even sentences they cannot express otherwise. mit harnesses the singing ability of patients with non-fluent aphasia as a means to improve their communication. although its exact nature depends on the therapist, in general mit relies on the use of intonation (the rising and falling of the voice) and rhythm (beat/speed) to train patients to produce phrases verbally. in mit, common words and phrases are turned into melodic phrases, generally starting with two step sing-song patterns and eventually emulating typical speech intonation and rhythmic patterns. a therapist will usually begin by introducing an intonation to their patient through humming. they will accompany this humming with a rhythm produced by the tapping of the left hand. at the same time, the therapist will introduce a visual stimuli of the written phrase to be learned. the therapist then sings the phrase with the patient, and ideally the patient is eventually able to sing the phrase on their own. with much repetition and through a process of "inner-rehearsal" (practicing internally hearing one's voice singing), a patient may eventually be able to produce the phrase verbally without singing. as the patient advances in therapy, the procedure can be adapted to give them more autonomy and to teach them more complex phrases. through the use of mit, a non-fluent aphasic patient can be taught numerous phrases which aid them to communicate and function during daily life. the mechanisms of this success are yet to be fully understood. it is commonly agreed that while speech is lateralized mostly to the left hemisphere (for right-handed and most left-handed individuals), some speech functionality is also distributed in the right hemisphere. mit is thought to stimulate these right language areas through the activation of music processing areas also in the right hemisphere similarly, the rhythmic tapping of the left hand stimulates the right sensorimotor cortex to further