Healing with Music
Publication: Caring Today: Practical Advice for the Family Caregiver
Author / Writer: Deborah Harkins
What balm can doctors or caregivers offer a human being whose life has been derailed by a devastating impairment—dementia, say, or a crippling accident, or paralysis, or the loss of the ability to speak? They can give the gift of music.
Scientists are just beginning to understand the power that music has in helping the severely disabled. What today’s brain researchers are learning is that music has the ability not only to calm, to stimulate and to trigger elation, but also to heal.
Researchers at the Institute of Music and Neurologic Function, a nonprofit research center founded in 1995 in New York City, study music’s “extraordinary power to awaken, stimulate and heal” as they work with severely disabled patients at the Beth Abraham long-term residential care facility. Concetta Tomaino, DA, a board-certified music therapist and the institute’s director, has seen music decrease agitation and stimulate memory in patients with dementia, help stroke patients recover the power of speech, strengthen muscle groups and increase range of motion in patients beyond the help of traditional rehabilitation. Music even helps certain patients with Parkinson’s disease, traumatic brain injury, stroke or other neuromuscular problems regain the ability to walk.
“It’s clear that the way music works is through its effect on the emotions,” says neurologist Steven Sparr, MD, and institute adviser who is a professor of neurorehabilitation at the Albert Einstein College of Medicine in New York City. “And the emotions are very powerful moving forces in the behavior of certain muscles. For instance, without emotion a patient with facial palsy cannot smile – his muscles are paralyzed. And yet, if you can get him to laugh, the paralysis disappears.”
Dr. Sparr confirms that in studies, music therapy has decreased the frequency of seizures when played in an epilepsy ward, improved the walking cadence of patients with Parkinson’s disease and allowed dementia patients to regain the ability to speak and relate to other people. But in reality, he notes, many studies also show that these benefits last only as long as the music is playing. The hoped-for goal is to discover how to make the benefits of music long lasting, “generalized to the patient’s life,” like the benefits of physical therapy.
Harnessing the Power of Music
All across the country, music therapists – proficient musicians who have received training in anatomy, psychology, physiology and special education – are at work in hospitals, nursing homes, rehab centers, schools and hospices, employing the techniques Dr. Tomaino and her colleagues are using. (To earn a four-year bachelor’s degree in music therapy, a student must successfully complete a full-time clinical internship; he or she can go on to a master’s or doctoral degree and must sit for a national certifying examination offered by the Certification Board for Music Therapists.)
“Most people are just awed by the power of music to awaken a person with Alzheimer’s disease,” says music therapist Al Bumanis, a spokesman for the American Music Therapy Association, based in Silver Spring, Maryland. Many dementia patients who can no longer speak or recognize faces show a heartening – and startling – response to “their kind of music.” They actually sing along with the melody. Or, if they don’t sing, they mouth the words.
“Over the 25 years I’ve been here at the institute,” Dr. Tomaino notes, I’ve been told by doctors and psychiatrists that some of the individuals we treat have no ability to comprehend anything. My reply? ‘You can’t say that.’ These patients with advanced Alzheimer’s recognize the melody I’m playing. They process this music and give back the words, and you can see the emotion attached. And when I play the music over and over, I get new responses. That’s comprehension, at least at some level.
“Late-stage Alzheimer’s is scary. We are all afraid of pain and the unknown, and late-stage patients seem so tormented,” continues Dr. Tomaino. “It’s a great comfort for caregivers to know that through music, people locked in such isolation can have happy moments – moments of interaction with others, moments of some connection to themselves.”
Alzheimer’s specialist Gayatri Devi, MD, an attending physician at Lenox Hill Hospital in New York City and director of New York Memory and Healthy Aging Services in New York City, agrees.
“We know that music therapy provides real benefits for both Alzheimer’s patients and their caregivers,” she says. Dr. Devi acknowledges, however, that “Generally, music therapy studies have not been the kind of well-controlled studies that are the gold standard in research. Even so, we have good studies that show that playing the patient’s favorite music improves his sleep; playing it when he’s bathing decreases his agitation and hitting behavior and increases his compliance; playing it at mealtime may improve his appetite.”
In a recent, but very small study in Japan, she notes, the speech of 6 or 10 Alzheimer’s patients improved—and stayed improved—after music therapy. In a sleep study, Alzheimer’s patients were shown to sleep better for six weeks after their month-long exposure to music therapy. (This benefit was clear not only from observation, but by measurement of the patients’ melatonin levels.) Says Dr. Devi, “Incorporating music therapy into a patient’s life is a no-brainer, considering that it’s so inexpensive and that these studies show beneficial effects and no negative effects.”
Still, Jed Levine, executive vice-president and director of programs for the New York City chapter of the Alzheimer’s Association, sounds a cautionary note. “Like all the techniques we suggest to caregivers, music therapy isn’t going to work 100 percent of the time,” he says. “I can hear exhausted caregivers thinking, ‘Oh, God, this is one more thing I should be doing. I’ve had it!’ Caregivers have so many demands laid on them, I’m afraid they may see this not as a helpful tool, but as another demand.”
A Song in Your Heart
Because, as Dr. Sparr points out, music is a direct channel into the emotions, you are likely to bring rare moments of pleasure into the life of a loved one with dementia if you play a CD of favorite music, or see that he or she has a chance—at a senior center or adult day program, for example—to sing along with others.
What seems to work best is playing the music that the person has always loved. So if your mother had a passion for Handel, a Beethoven concerto not cam her agitation the way Handel’s “Water Music” would; if she delighted in the wonderful pop ballads of the twenties through the fifties, then jazz or blues or calypso may not be as effective in soothing or stimulating her. Her favorite music is a channel into her very self. Still, Dr. Tomaino says, if you want to energize a patient, playing something that’s upbeat and rhythmic can get her moving, even if the music is unfamiliar.
How does music affect the brain? An experiment at McGill University, in Canada, in 2001 showed that listening to a beloved symphony or song can release brain chemicals that trigger chills of delight.
The McGill scientists asked participants—all classical musicians—to listen to a favorite piece of music that they had brought into the lab. Functional brain imaging showed that the music stimulated the areas of the participant’s brain that release dopamine and other euphoria-inducing opioids and that the listener got chills down his spine. But when some other piece of music was played for the participant, no chills of pleasure were induced.
“If you know the patient well, you know what kind of music he likes,” Levine points out. “Long ago, I ran a day program for dementia patients. When one of my clients became agitated, I knew what to do: I’d sing with her. The only kind of music she knew was church music, so singing “The Old Rugged Cross” and Fanny Crosby would engage her in a way nothing else could.” For another patient, a Walkman worked. “By sitting and listening to his favorite music,” Levine says, “he could tolerate being in the day program.” That didn’t work for all patients, though. Some would tear their headphones off. (And it must be noted that playing music that an agitated patient doesn’t like will increase his distress.)
Barbara Reuer, PhD, a board-certified music therapist who is director of MusicWorx of California, a practice in San Diego, notes that composing songs helps patients express emotions; playing a rhythm instrument can release unspoken feelings; melody can recall memories associated with lyrics and singing relaxes muscles, oxygenates the body and lifts the spirits.
Breathing to a rhythm, for example, can relax and sedate. Toning (making a sound with an elongated vowel for an extended period of time) causes the body to vibrate in a specific area, depending on whether the sound is, say, ooooh (which affects the pelvic area) or aaaah (which affects the chest). This can be a diversion from pain and a catalyst for emotional release.
Dr. Reuer also teaches hospice volunteers the benefits of deep breathing, humming—and even moaning—for patients in pain. “When we intuitively go ‘aaaah,’ our bodies know to release,” she says. “We teach caregivers not only to soothe their loved one by singing or humming familiar songs, but to also hum when the patient moans or groans. They should imitate the sounds and turn them into humming. To say, ‘aaaah’ distracts the patient from the pain, and humming gives an internal massage. Say ‘aaaah’ and put your hand over your heart and you’ll feel the vibrations.”
Though music is not a cure disability, Dr. Tomaino points out, “It lets us stimulate function in patients whose neurological damage (stroke, Alzheimer’s, Parkinson’s, traumatic brain injury) puts them beyond the help of traditional medicine. In a very specific way, music can excite areas of the brain that have been dormant; it can turn on verbal or visual pathways that cannot be accessed by other therapies.”
And sometimes music therapy brings not only pleasure but verbal or physical improvement. People who have suffered a stroke in the left temporal area of the brain develop “non-fluent aphasia,” she explains. They have trouble putting together meaningful words and phrases. Because singing uses a parallel region of the right side of the brain, these patients can often sing the words of a song with a flexibility and ease that is absent when they try to speak the words. “We’ve seen many patients who, after they’ve sung lyrics they know, become better able to independently form meaningful phrases,” Dr. Tomaino says.
Song writing is a significant tool for dealing with bitterness, frustration, grief and pain, music therapists have found. And this creative pleasure is accessible to ordinary people: Almost everyone, it seams, has a song in his heart.
To read the poignant stories of several patients at Beth Abraham whose song creation helps them cope with their grievous losses, you can visit the website of the Institute for Music and Neurologic Function at www.musichaspower.org. Writing songs and making multi-track recordings, for example, helps Jeremy, whose arms had to be amputated after a horrific assault, get through the day. And Trevor Gibbons, immobilized by several strokes, finds an escape from sadness, loneliness and pain when he writes and sings his own gospel music.
So how do you get a non-musician to write a song? Start with a song parody, Dr. Reuer says. Play or sing “You Are My Sunshine” and ask the patient to substitute something for the word “sunshine.” This provokes all sorts of inventive responses, including this rueful refrain, composed by several of Dr. Reuer’s patients: “You are my tofu, my only tofu/you make me gassy when I eat you/You’ll never know, dear, how much I hate you/Please don’t take my chicken away!”
“Patients sometimes write about how much they hate a particular exercise or a particular physical therapy session,” says Dr. Reuer, “but the song always ends, ‘Oh, but this is good for me.’ And then they can laugh about it and share it with their physical therapist.”
Once they get started, patients go on to become astonishingly creative. The songs written by hospice patients can be very poignant. “One of the most beautiful songs I’ve heard a patient create,” says Dr. Reuer, “was written by a woman with a brain tumor. She was standing at the window looking out at her children, and she wrote a poem that we put to music—a reflection about what would happen to her children after she died.”
Whether or not caregivers choose to use music therapy to help a patient, Levine suggests that they use music therapeutically for themselves. For scientific studies are beginning to validate what we all intuitively understand: The joy of singing in a chorus has restorative power; so does spending a night at the opera, the symphony, a jazz club, an Irish pub, or wherever else you can delight in the particular sort of music—sublime, effervescent, plaintive, foot-stomping, earthy—that resonates with you. [ end ]