Hearing the music, healing the brain
By Matthew Shulman
U.S. News and World Report
Article Last Updated: 09/07/2008 02:08:57 PM MDT

 Music therapy is helping patients regain abilities lost to Parkinson's, 
Alzheimer's and strokes.
Rande Davis Gedaliah's 2003 diagnosis of Parkinson's disease 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 trigger the release of mood-altering brain 
chemicals and once-lost memories and emotions.
Humans born for the beat
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 help 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."
Dramatic recoveries
Trevor Gibbons, 51, can vouch for the brain's flexibility. A patient at Beth 
Abraham Rehabilitation Center in New York City, 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.
After 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 New 
York's Lincoln Center. (Pre-stroke, says Gibbons, he sang only in his church 
choir.)
As Gibbons did, 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 calming music can lower blood pressure rates, and last 
year Spanish research showed listening to music before 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 after 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 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 the 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.

Rayilyn Brown
Director AZNPF
Arizona Chapter National Parkinson Foundation
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