You Are the Music: How Music Reveals What it Means to be Human (24 page)

All this research suggests that a music intervention which strengthens the basic auditory skills of children with dyslexia and other reading difficulties, especially one that incorporates rhythm, may help support their language learning.
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At present there are no clinically accepted trials from which to draw
firm conclusions about how music education may help reading,
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but hopefully such studies will emerge in the future, with useful guidelines for best implementation.

The future

There has been a small but significant explosion in music therapy and music medicine to support children’s development and care over the last decade, and I have just touched on some of the areas here.

In practical terms there are proving to be lots of opportunities for musicians, psychologists, doctors, carers and engineers to come together and build useful technology to support these efforts. A project that acts as an example of this is the Virtual Musical Instrument (VMI).
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The VMI is a visual computer interface that allows people with varying levels of mobility to create nice musical sounds in response to body movements. Eneko would love that. Such new music rehabilitation tools hold great promise for therapists, families and children.

Music and physical well-being in adults

In this section I will talk about conditions that are more likely to strike in adulthood, such as serious brain injury, stroke, conditions like Parkinson’s, and mental illness. Here we will see how music can help with recovery, re-learning and rehabilitation. I will refer often to the Cochrane reports, systematic reviews of research in health care that are internationally recognised as the gold standard in evidence-based health care.
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We begin with brain injury. Our brain is a wonderfully complex thing, which of course means that it can break down in a myriad of diverse ways. Misfortune can visit in the form of traumatic accidents, stroke, illnesses, infection and toxic exposure (for example, to carbon monoxide). More people than ever survive such life events thanks to the advances of modern medicine.

Let’s be clear. Music is unlikely to help you survive a brain injury. But it could have a useful role in recovery.

Let’s assume the worst first: that a brain injury or illness causes a spell in a coma or similarly altered state of consciousness, and a stay within intensive care, probably on a ventilator. How can music help in these circumstances?

Coma and ventilation

Even in the deepest states of unconsciousness a person may continue to hear the world around them.
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This means that music therapy is possible when someone is in a coma. Therapists can improvise singing or playing instruments to the rhythms of a pulse or breathing pattern.
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These kinds of techniques can set up a channel of communication, an outside link for a patient in a coma.

Measurements taken during such music therapy sessions indicate that coma patients often show signs of relaxation (for example, their breathing settles on a steady, slow rate). EEG recordings of brain activity have also shown that the types of brain waves that are prominent during therapy are associated with a relaxed state. Importantly, a coma patient can respond to quiet and gentle singing, even in a noisy hospital environment.
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The Cochrane reviews noted many cases where music therapy and music medicine (listening to calming music) can reduce heart and breathing rate, and help keep coma patients stable over a period of time. Other physiology measures, such as blood pressure, respond less reliably to music interventions in ventilated patients, a result which offers a welcome cautionary note about expecting too much of music interventions in patients who are critically ill and heavily medicated.

To date, however, because of the positive indicators and since music listening is an easy intervention to implement, the Cochrane review has concluded that music listening should
be offered as a stress management intervention to coma and ventilated patients.
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Stroke

A stroke happens when blood flow in the brain is disrupted by a leakage or a blockage. Cases of stroke are on the rise, partly due to the increase in our life expectancies. Worldwide, fifteen million people suffer a stroke every year. The World Health Organization (WHO) predicts that the disability-adjusted life years lost to stroke will rise from 38 million in 1990 to 61 million in 2020.
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Teppo Särkämö has studied music in the recovering brain at the Cognitive Brain Research Unit in Finland.
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In his thesis Särkämö explored the impact of music listening on stroke patients against listening to audio books or no listening activity. All the patients had a thorough neurological examination six months post-stroke to check on their progress. Both the music listening and the audio book patients showed improvements to their auditory processing, but only the music listening group showed a benefit to their verbal memory and focused attention. Music listening was also found to be better for tackling feelings of depression and confusion. This research strongly supported the inclusion of music as a ‘rehabilitative leisure activity after a stroke’.

Music therapy has been found to be helpful in cases of unilateral neglect after stroke. Neglect happens when a stroke patient seems to be unaware of part of their environment despite no problems with their vision. Patients with neglect may only eat part of the food on a plate or shave only part of their face. Listening to classical music has been associated with improvements to attention in patients’ otherwise neglected field.
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Music therapy, in particular the use of playing scales on chime bars, has also been found to help patients reorient to their neglected field.
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Movement

Around 80 per cent of stroke patients experience a loss of mobility. Mobility is also a primary issue in conditions such as Parkinson’s, where damage to the dopamine regulatory processes and basal ganglia in the brain leads to disrupted physical movements. Stroke and Parkinson’s patients face different challenges to recovery and remediation of their condition but music therapy can support movement for both populations, and potentially for other groups where motion is an issue.

A simple metrical rhythm can help guide patients to walk with less rigid motion and at a steadier pace.
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This kind of music therapy has become known as rhythmic auditory stimulation (RAS) and has been developed greatly in the last ten years. RAS typically consists of metronome-pulse patterns embedded into rhythmically accentuated instrumental music. Some patients can have measurable improvements in their walking within 24 hours of a first RAS training session.

Although the biological mechanism by which rhythmic music can help support walking and other movements is not yet certain, it is thought that having an ‘external timekeeper’ helps patients to synchronise their motor movements as opposed to relying on the disrupted internal timing signals from compromised areas of the brain.
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The Cochrane reports found several studies where RAS was associated with better walking in stroke patients, including improved speed, stride length and symmetry, all of which makes for a steadier and safer pedestrian.
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These studies took place in the presence of a music therapist but I have heard many anecdotal reports of patients listening to and even composing music on their own to help with their movements.

One of the latest developments in this field is called ‘Walk-Mate’. While steady RAS rhythms may be helpful, they are not very adaptable if a person starts to struggle or speed up their pace. Walk-Mate is a project that features interactive
and real-time responsive rhythmic sound to support movement.
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It is still early days for this technology but results have shown even more advanced therapeutic benefits compared to fixed RAS.

Speaking

Disrupted motor movements may also impact on speech. Aphasia, a word which originates from the Greek for ‘speechless’, is another common symptom post brain injury or stroke. Aphasia can relate to the understanding or comprehension of language as well as the production or expression of speech. There are a huge variety of aphasic conditions but music therapy offers new hope for those who struggle to speak after brain injury.

Many of you will be familiar with the case of Gabrielle Giffords, a Member of the United States House of Representatives who was the victim of an assassination attempt in early 2011. Gabby, as she is known, was left fighting for her life with severe brain injuries after being shot in the left temple. Despite such a devastating injury, after much hard work in recovery, Gabby was able to address the US Congress just over one year later. She credits music therapy for its part in helping her incredible progress in regaining her speech.

I have already discussed how a form of music therapy, AMMT, can help speech production in autistic children who struggle with verbal development. AMMT grew out of an earlier development in music therapy that has helped speech recovery in many adults post brain injury: melodic intonation therapy (MIT).
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The reports and images of Gabby Giffords’ music therapy seem to suggest it followed a similar protocol to MIT.

During MIT a therapist will use sung patterns of exaggerated speech, beginning with just two different pitches (one high and one low) and eventually accompanied by well-known
melodies like lullabies. The therapist will also tap the rhythm of the singing with the patient’s left hand.

MIT is most successful in people who have had left hemisphere strokes
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or brain damage, like Gabby; such an injury would typically damage language ability. It is important that the right hemisphere is relatively spared as MIT helps to retrain that part of the brain to support speech.
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Specifically, MIT has been associated with the increased recruitment of parallel circuits in the right hemisphere that would normally support language in the left hemisphere, such as premotor areas (for speech planning) and the superior temporal lobe (sound analysis), as well as crucial white matter pathways that connect these areas.

The mechanism behind MIT is not yet certain and there is an ongoing debate about which aspects of MIT are actually having an effect. Some claim that singing is not necessary, that the rhythmic content is most helpful for regaining speech.
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One important point that such studies overlook is that real music may work well as it is engaging and fun. At the time of writing, this debate rumbles on. What is undeniable is that music therapy has played a crucial role in the speech recovery of many people such as Gabby Giffords.

To end this section on physical health I want to touch on two of the biggest killers in modern society: cancer and heart disease. Music will never cure either of these life-threatening conditions but thanks to many of the effects of music medicine and music therapy that we have already discussed (increased relaxation, reduced pain), as well as secondary effects (better sleep,
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faster response to treatment, better perceived quality of life), music can help to support recovery from cancer and heart disease, and aid in the experience of what can be painful and distressing (although necessary) treatments.

Several trials of music therapy and music medicine in cancer patients have shown measurable effects on the autonomic relaxation response. Listening to music can reduce heart rate by an average of 4 beats per minute (bpm) and respiratory rate by an average of two breaths per minute,
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with some comparable reduction in blood pressure. Similar results have been reported in patients with heart disease.
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Those changes may seem small but each average 10 bpm reduction in heart rate may reduce the risk of cardiac death by up to 30 per cent.
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Having a tool that can trigger real physiological relaxation in this way over time also has far reaching effects for how people feel from day to day. The Cochrane reports suggest that music therapy and music medicine interventions have a beneficial effect on anxiety, mood and quality of life measures in people with cancer. The results of some trials suggested that music also has a moderate pain-reducing effect. Finally, the autonomic relaxation response reportedly reduces muscular tension and vessel constriction – thereby increasing the success rate of painful procedures.
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Music and mental well-being in adults

Given the positive impacts of music therapy and music medicine on the body it should come as no surprise that there is also potential for the treatment of mental health and well-being.

A recent review of the past twenty years of research in this area
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reported that music therapy, in particular active music making, can be used as a complementary therapy in the treatment of depression,
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schizophrenia,
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and dementia,
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as well as problems of agitation, anxiety, sleeplessness and substance misuse. Just a few sessions can be enough to see small measurable effects in symptoms, though larger numbers of sessions (16–51) achieve better results; this finding suggests that it might be a case of the more treatment sessions, the better.
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I will touch on three specific areas of music and mental
well-being here to bring our journey through music and well-being to a close.