Patients with Alzheimer's disease, an irreversible neurodegenerative condition with progressive deterioration of cognitive and behavioral functions, pose serious questions in terms of treatment and care (Arkin, 2007, Fernandez et al., 2006, Giovannetti et al., 2007, Gitlin et al., 2008, Graff et al., 2008, Mihailidis et al., 2007 and Raggi et al., 2007). The general view is that, beside pharmacological interventions, these patients need the support of behavioral strategies to manage activity engagement or other forms of positive participation (Ferrero-Arias et al., 2011, Giordano et al., 2010, Hulme et al., 2010, Padilla, 2011, Phinney et al., 2007, Vernooij-Dassen, 2007 and Wood et al., 2009). For example, patients who are within the mild and higher half of the moderate stage of the disease may learn to use systematic (technology-aided) instruction strategies to manage the performance of relevant daily activities (Lancioni et al., 2008, Lancioni et al., 2010, Lancioni et al., 2012, Lancioni et al., 2009a, Lancioni et al., 2009b and Lancioni et al., 2009c).
Patients in the severe and, possibly, lower end of the moderate stage of the disease would not be able to benefit from those strategies and perform daily activities. Rather, they might benefit from the availability of music stimulation employed as a strategy to reduce their behavioral disturbances and improve their participation and mood (Gerdner, 2000, Guétin et al., 2009, Hicks-Moore and Robinson, 2008, Janata, 2012, Raglio et al., 2010 and Zare et al., 2010). Music stimulation can be envisaged and implemented in different ways. For example, some studies have reported the active involvement of a therapist or professional musician in playing music directly to the patients (Cevasco, 2010, Chatterton et al., 2010, Gotell et al., 2009 and Ho et al., 2011). Other studies have relied on the simple presentation of music recordings (i.e., without any specific musician or therapist participation) (Gerdner, 2000, Raglio and Giannelli, 2009, Svansdottir and Snaedal, 2006, Wall and Duffy, 2010, Wollen, 2010 and Zare et al., 2010).
Recently, an effort was made to enable patients diagnosed in the severe and low moderate stages of the disease to regulate their music input. To this end, a basic technology was used that (a) allowed them to determine the continuation of the music stimulation via simple microswitch responses and (b) reminded them about (reoriented them on) the responses and music in case of response failures (i.e., attention/memory blips that can occur in their condition) (Lancioni et al., in press). An active (self-regulated) stimulation approach was deemed useful for (a) allowing the patients to exercise a form of adaptive (reality-oriented) behavior considered relevant to counter their gradual detachment from the immediate reality/context and (b) providing them a more positive and socially acceptable image (Giordano et al., 2010, Raggi et al., 2007, Smith-Marchese, 1994 and Wollen, 2010). The results for the 10 patients involved in the study indicated that the impact of the active music condition on the patients’ positive participation (e.g., music-related movements, positive verbal comments, and smiles) was largely comparable with the impact of a passive (environmentally arranged) music condition. The social ratings of 140 university psychology students significantly favored the active music condition on a six-item questionnaire dealing with, among others, conditions’ suitability, respect of patients’ dignity and independence, and practicality.
In light of these preliminary research results, one could argue that an active music stimulation condition supported by adequate technology can be viable, effective, and socially preferable. The present study was aimed at extending such research by (a) comparing the impact of an active, technology-supported music condition with the impact of a passive music condition with six new patients and (b) conducting a social validation assessment of the two conditions with raters who had practical experience in the care and rehabilitation of patients with multiple disabilities (i.e., with patients presenting a range of problems similar to those occurring in the severe and low moderate stages of the Alzheimer's disease) (Callahan et al., 2008 and Kennedy, 2005).
