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Sunday, July 20, 2008

Music as Medicine for the Brain

US News reports on how some neurologists are prescribing music for conditions from Parkinson's and Alzheimer's to stroke and depression. Matthew Shulman writes,

Listening_to_musicRande Davis Gedaliah's 2003 diagnosis of Parkinson's was followed by leg spasms, balance problems, difficulty walking, and ultimately a serious fall in the shower. But something remarkable happened when the 60-year-old public speaking coach turned to an oldies station on her shower radio: She could move her leg with ease, her balance improved, and, she couldn't stop dancing. Now, she puts on her iPod and pumps in Springsteen's "Born in the U.S.A." when she wants to walk quickly; for a slower pace, Queen's "We Are the Champions" does the trick.

Music therapy has been practiced for decades as a way to treat neurological conditions from Parkinson's to Alzheimer's to anxiety and depression. Now, advances in neuroscience and brain imaging are revealing what's actually happening in the brain as patients listen to music or play instruments and why the therapy works. "It's been substantiated only in the last year or two that music therapy can help restore the loss of expressive language in patients with aphasia" following brain injury from stroke, says Oliver Sacks, the noted neurologist and professor at Columbia University, who explored the link between music and the brain in his recent book Musicophilia. Beyond improving movement and speech, he says, music can trig ger the release of mood-altering brain chemicals and once-lost memories and emotions.

Parkinson's and stroke patients benefit, neurologists believe, because the human brain is innately attuned to respond to highly rhythmic music; in fact, says Sacks, our nervous system is unique among mammals in its automatic tendency to go into foot-tapping mode. In Parkinson's patients with bradykinesia, or difficulty initiating movement, it's thought that the music triggers networks of neurons to translate the cadence into organized movement. "We see patients develop something like an auditory timing mechanism," says Concetta Tomaino, cofounder of the Institute for Music and Neurologic Function in New York City. "Someone who is frozen can immediately release and begin walking. Or if they have balance problems, they can coordinate their steps to synchronize with the music," improving their gait and stride. Slow rhythms can ease the muscle bursts and jerky motions of Parkinson's patients with involuntary tremors.

Actually playing music, which requires coordinating muscle movements and developing an ear for timing, can also bring dramatic results, says Rick Bausman, a musician and the founder and director of the Martha's Vineyard-based Drum Workshop. The workshop uses traditional drum ensembles, in which groups of participants play percussion pieces, as one form of therapy for patients with a variety of cognitive and physical disabilities, including Parkinson's disease. Bausman teaches participants to play along with traditional Afro-Caribbean beats like the Haitian kongo and Cuban bembe using congas, bongos, and djun-djun drums. "Participants report that their control of physical movement improves after playing the drums, their motion becomes more fluid, they don't shake quite as much, and their tremors seem to calm down," says Bausman.

Indeed, research on the effects of music therapy in Parkinson's patients has found motor control to be better in those who participated in group music sessions—improvisation with pianos, drums, cymbals, and xylophones—than in people who underwent traditional physical therapy. But gains were no longer evident two months after the sessions ended, so the best results require continued therapy. To stay motivated, Tomaino recommends seeking out both therapeutic drumming groups like Bausman's and social dance classes. Patients can also create music libraries for CDs or MP3 players that can be used to facilitate walking.

Because the area of the brain that processes music overlaps with speech networks, neurologists have found that a technique called melodic intonation therapy is effective at retraining patients to speak by transferring existing neuronal pathways or creating new ones. "Even after a stroke that damages the left side of the brain—the center of speech—some patients can still sing complete lyrics to songs," says Tomaino. With repetition, the therapist can begin removing the music, allowing the patient to speak the song lyrics and eventually substitute regular phrases in their place. "As they try to recall words that have a similar contextual meaning to the lyrics, their word retrieval and speech improves," she says.

The technique appears to activate areas on the right side of the brain, suggesting that these areas pick up the slack for the damaged left side, according to Gottfried Schlaug, a Harvard neurologist whose ongoing research uses functional MRI scans to study language recovery in stroke patients. "It's startling to see these images," says Sacks, "one would not expect to see such plasticity in the human adult brain."

Trevor Gibbons, 51, can vouch for the brain's flexibility. A patient at Beth Abraham Rehabilitation Center in the Bronx, where Tomaino heads the music therapy program and where Sacks first began treating chronically ill patients decades ago, Gibbons has been able to restore his speech after suffering a devastating spinal injury from a four-story fall and a stroke in 2000. The former carpenter says that before he began vocal training and playing piano with music therapists at the clinic, he couldn't speak or move and would lie for days in bed, depressed. Following intensive sessions three times a week over several years, Gibbons not only recovered his speech but also has written more than 400 songs, recorded three CDs, and performed at a benefit fundraiser for Beth Abraham at Lincoln Center. (Pre-stroke, says Gibbons, he sang only in his church choir.) His depression has improved, too. "It gave me motivation and a chance to look forward to live another day," he says.

Like Gibbons, patients often report more positive moods following sessions. This may be because of an increase in the production of neurotransmitters like norepinephrine and melatonin, suggested a 1999 study by researchers from the University of Miami School of Medicine. Several studies have shown that calming music can lower blood pressure rates, and last year a Spanish investigation showed that listening to music prior to surgery decreased anxiety, heart rate, and levels of the stress hormone cortisol as much as the anti-anxiety drug diazepam. Stress and anxiety relief, in fact, may be one reason music can help people with Alzheimer's and dementia uncover memories that seemed irrecoverable, experts say. Researchers reported in 2006 that enhanced memory recall accompanied significant reductions in anxiety when Alzheimer's patients listened to the "Spring Movement" from Vivaldi's Four Seasons.

Set at ease by familiar melodies, they may be more apt to communicate, too. Even people at advanced stages of the disease sometimes see improvements in attention and alertness, sociability, and overall functioning following music therapy. The reason, experts suspect, is that music stimulates areas deep within the amygdala and hippocampus, where emotion and long-term memory are processed. Both are less prone to the degenerative effects of Alzheimer's than the outer cortex, the hub for complex thought. Music played at a wedding, a religious service, favorite songs from childhood, or concerts from the teenage years or young adulthood can serve as cues to recover memories, says Suzanne Hanser, founder of the music therapy department at Berklee College of Music in Boston and a practicing therapist at the Dana-Farber Cancer Institute.

Not everyone will respond, and it may take several sessions to see any effect, says Hanser. She finds that simple stress reduction techniques such as facial massage or muscle release exercises can often enhance the music's magic.

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