You Are the Music: How Music Reveals What it Means to be Human (23 page)

Having laid down definitions and cautionary notes, we can now proceed into the research itself. I will touch on general well-being in several places in the next section, which moves in life stages from infancy right the way through to end-of-life care, but I will focus on music medicine and music therapy for brain, body and behaviour syndromes and developmental issues.

Music and well-being in infants

Premature babies

In Chapter 1 I talked about the development of human hearing in the womb. Sometime between the fourth and sixth month of pregnancy a foetus will develop the physiological structures in the ear and brain that are necessary to perceive sound. When a full-term baby is born it has had months of experience of hearing the muffled rhythms and melodies of sound that pass into its fluid-filled environment. You might think of this as the ‘music of the womb’.

Sadly, not all babies reach full term. Happily, medical science has made remarkable steps when it comes to caring for babies born as young as 22–23 weeks, such that many go on to survive. The priority for these premature babies is to take care of their underdeveloped organs and support their growth to maturity as far as possible.

At a conference called ‘Music and Neurosciences’ in 2011 I first heard about the work of Amir Lahav, director of the Neonatal Research Lab at Brigham and Women’s Hospital in Boston, Massachusetts. Lahav had just completed a series of studies in which he simulated a neonatal hearing environment for premature babies. Why would he do this? Surely there are more important matters than worrying about hearing in a premature baby?

Consider for a minute the auditory environment inside a neonatal intensive care unit (NICU): quiet but with occasional loud machines bleeping and buzzing, intermittent piercing alarms, medics shouting important, emergency instructions. All that noise constitutes massive overexposure if your tiny ears have only just begun to process sound.

Lahav and his research team reasoned that babies who reach term in the womb get a much gentler and informationrich introduction to sound over several months that helps to develop the fine structures in the ear and the auditory cortices in the brain. Through this early, muffled, music-like exposure, their brain develops invaluable pattern-recognition and memory skills which will be important for later development of speech and language comprehension. Before they are even born, babies come to know important rhythms and melodies like their mother’s voice, heartbeat and breathing patterns.

Lahav decided to try and replace some of this lost opportunity for brain and ear sound experience in premature babies by simulating a neonatal sound environment in their NICU cots. He speculated that recreating, in particular, the maternal speech that the babies would hear in the womb may also have benefits for the development of their tiny bodies, by minimising heart and breathing stress responses.

The researchers introduced recordings of mothers’ voices and heartbeats into the NICU environment of fourteen premature babies (born between 26 and 32 weeks) by way of a
specially created mini-audio system.
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The babies served as their own control group, as they heard normal hospital sounds as well as maternal sounds. The researchers monitored the number of times babies experienced adverse breathing and heart responses and found that these were significantly lower when the babies were listening to their mother’s voice and heartbeat.

This study does not use ‘music’ in the traditional sense, but remember that infants at six months’ gestation would never hear music in the way that we can. They would hear muffled pitch patterns (melodies) and rhythms filtered by the womb.

Exposing premature babies to real music in an NICU also leads to promising outcomes according to a two-and-a-halfyear study of eleven different hospital sites, led by Joanne Loewy. She showed that live music therapy in NICUs (by a qualified therapist, making use of singing and instruments) had measurable beneficial impacts on babies’ vital signs and sleep patterns.
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Music therapy was a crucial choice in the above study, as a therapist can react flexibly to changes in a baby’s breathing, heart rate or movement patterns. Positive effects of music have also been seen in the way that premature babies respond to necessary but often painful and stressful procedures.
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There is a tendency for clinicians to be concerned – rightly – about the negative impact of noise in an NICU, including music.
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But given the presence of predictable structures like melody and rhythm, it is reasonable to hypothesise that soft, simple music that reduces the possibility for over-stimulation would be supportive for developing ears as well as minds and bodies in premature babies, especially when combined with the sounds of maternal speech and heartbeats.
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Guidelines for music use in NICUs have been created with this in mind.
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Another problem for premature babies is feeding. Weight gain is one of the most important factors in healthy premature development but babies born before 34 weeks often have pronounced difficulties coordinating sucking, breathing and swallowing. They can be tube fed, though this increases the risk of stress responses and can stall development of musculature in the gastrointestinal system. In short, it is important to encourage a premature baby to learn how to feed as soon as possible.

Work by Jayne Standley
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established that music can be a valuable tool in helping to encourage premature infants to adapt their sucking reflex to feeding. Standley developed a pacifier that plays recordings of pleasant female singing when babies suck correctly, which can apparently help to speed up a baby’s ability to feed independently. The impact of lullabies on feeding, in combination with more traditional pacifiers, has also been supported by recent studies,
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though it has yet to be established whether music helps infants learn how to coordinate their sucking through rhythm or simply encourages them when they happen upon the right technique.

The challenges facing a premature infant are great as they fight to survive and grow outside of the protection of their mother’s womb. This period is a stressful time for all and wellchosen music, especially in the hands of a trained therapist, can help foster relaxation that has positive impacts on body and brain mechanisms. These effects have secondary benefits for processes such as sleep and feeding, which all contribute to development.

Music and well-being in children

I only have the space to touch on a few of the areas where music medicine and music therapy can help to support wellbeing in children who have been diagnosed with conditions that impact on their physical and/or mental development. All
of these conditions also exist in adults but I talk about them here as the majority of the research has looked at children. In theory there is no reason why this work could not be extended to adults in the future: as we know, the brain is capable of lifelong learning and change (see Chapter 3).

Autism spectrum

My beloved nephew Eneko has fragile X syndrome, a genetic syndrome that leads to a number of unique physical and mental characteristics, the latter of which resemble autistic traits. Eneko is a happy ten-year-old boy who I adore. Although he can barely speak, he is very ticklish, curious, and we laugh all the time when we play games. Because of his syndrome he can be quickly distressed by changes to the environment, loud noises or disruptions to his routine. He is crazy about music, in particular Vivaldi. I once got him a baton so he could conduct orchestras that he hears on CD or sees on the TV.

Music can be an invaluable way to communicate with children like Eneko who show autistic traits and who also may have very limited verbal output. Children on the autism spectrum can show unique sensitivity to musical sounds
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and at least 12 per cent of autism clinical interventions currently feature music-based activities.
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Music therapy, when compared to play therapy, can result in significant improvements in non-verbal and gestural communication, including eye contact and turn-taking behaviours.
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Adding in musical elements to vocal training has also been found to have beneficial impacts on low-functioning autistic children who are learning to speak.
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A related developmental challenge associated with severe autism is limited or absent verbal communication. One exciting breakthrough in this area has been the development of a music-based therapeutic technique that supports verbal learning. Catherine Wan is a researcher in the Music and
Neuroimaging Laboratory in Boston where she developed Auditory-Motor Mapping Training (AMMT), an intervention to help non-verbal autistic children.

AMMT purports to encourage auditory-motor mappings in the brain by teaching children to speak at different pitches while playing tuned drums. While this kind of therapy is still in the early stages of development, it appears that AMMT sessions are associated with significant improvements in speech production even in children who have uttered hardly a word their whole lives.
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Children on the autistic spectrum may also benefit from movement therapy to help them learn coordination and control behaviours. Eneko has equestrian therapy and his motor coordination seems to have benefited from his riding lessons. Combining music and movement therapy can have positive effects in helping children with autism to improve in restlessness, tantrum and inattentive behaviours. The rhythmic aspects of music in particular can help promote fine and gross motor skills.
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Meanwhile, I can report that Eneko’s conducting is going from strength to strength.

The latest review on the subject of music therapy on the autistic spectrum
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has laid down several useful guidelines for clinicians, including the use of better measures of movement skills and placing a higher priority on interactive musical therapies that feature singing, music making and synchronised rhythmic activities. All signs point towards these kind of group-based social therapies being more effective than passive music listening.

ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a multisymptomatic condition that is marked by impulsivity, hyperactivity and a difficulty in focusing attention. These behaviours are associated with maladaptive outcomes including poor
educational attainment and fractured peer/family relationships. The condition is most frequently diagnosed in childhood and currently affects somewhere between 6 and 8 per cent of children in the UK.

Given the controversy surrounding medication for ADHD, there is a growing pressure to investigate alternative therapies. Interest in music therapy for ADHD stems from a desire to provide structured and focused activities that capture attention and allow for personal expression while requiring a degree of cooperation with others.

Interactive music therapy can also help children with ADHD to tap into their emotional reactions in a safe and supportive environment and to learn how to recognise and respond to shifts in mood.

To date, studies have reported generally favourable outcomes,
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although there are individual differences meaning that some children benefit from music compared to other visual therapies whereas others can be adversely responsive.
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A review of music therapy trials in ADHD that met excellent clinical standards
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is being conducted at the time of writing and conclusions should be available in the near future.

Dyslexia

Dyslexia is a broad term that encompasses learning difficulties centred on reading and spelling. Severity of dyslexia varies widely and difficulties can extend into verbal memory and verbal processing speed. The NHS’s current estimate is that between 4 and 8 per cent of school children in England have some form of dyslexia.
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Music has been thought of as a therapy for dyslexia thanks partly to the similarities between music and language, including the fact that both use structured sounds that unfold rapidly over time. Music is not a language but there are many overlaps in the way that we process and integrate these two forms of
sound communication,
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and as such there may be scope for supporting language learning by boosting musical skills.

Studies of auditory brainstem response (see Chapter 2) have shown that children with dyslexia have less stable encoding of sound, further supporting the idea that musical training may aid the development and function of neurological systems that support reading (
see page 42
). One hope for future research is that musical training may be able to help steady these unstable representations in the brain.
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It has long been known that there is a small but significant relationship between reading and music-learning skills.
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Marie Forgeard and colleagues conducted an extensive study with normal-reading and dyslexic children to test the patterns in the relationship between music and reading.
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Their findings suggested a tight coupling between the types of sound skills that can be boosted by musical training and the types of sound skills that help support the development of reading skills, in all of the children.

One additional interesting avenue of music and dyslexia research is concerned with the influence of rhythm. In 2003 Katie Overy
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investigated whether musical support could help the timing issues that many children with dyslexia encounter.
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She found that dyslexic children often scored higher on musical aptitude tests compared to their control group counterparts, except in the area of timing skills. She suggested that supporting rhythmic training with music could help tune reading skills such as the ability to segment syllables in language, leading to easier comprehension and improved spelling.
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