We’ve come a long way in incorporating evidence-based methods into music therapy, and we’ve only just begun, said Concetta M. Tomaino, of the Institute for Music and Neurologic Function in the Bronx, New York, in her recent “Music and the Brain” lecture at the Library of Congress in Washington, D.C.
When she started working as a music therapist 32 years ago, “there was no neuroscience in music therapy,” she said. No one could explain why the people with severe dementia she worked with would respond to music and little else. But “lucky for us,” she said, the neuroscience community grew intrigued with the idea of using music as therapy and started investigating it, and “it’s only now that we’re able to say how this works.”
Tomaino is the latest in a string of lecturers at the Library this season who have described the power of music to improve,
maintain, and retrain brain function. She referred to the research presented by Gottfried Schlaug in December and Petr Janata in January while concentrating on how what we are learning has improved therapy in the real world for people with stroke, Parkinson’s disease, aphasia, and other motor and speech troubles. [She also wrote a piece for Cerebrum in 2002, “How Music Can Reach the Silenced Brain.”]
“Music is a whole-brain exercise,” she said. Because it is processed in many parts of the brain and uses many brain networks, music can offer
alternate gateways to an area that might have become cut off. For example, networks for rhythm and timing are, if not innate, laid down before a child is born. At four months’ gestation, a fetus can respond to “beat induction” (matching movement to a beat); as early as two days after birth, babies can distinguish the beat in a piece of music. This is a critical function, Tomaino said, because “sound gives instruction to the world around us.” Babies must quickly learn to respond to verbal commands, tone, speech patterns, and other aural cues. They also must learn to move in time, including the basic rhythm of walking.
That this capacity is so ingrained also means that if people lose their ability to move, as when their motor networks are damaged by Parkinson’s or after a stroke, their subcortical regions might be tapped to retrain or rewire the motor system. “Using auditory cues, we can reimbue them with this ability,” she said. Tomaino showed a video clip of a woman with Parkinson’s shuffling toward the camera; when the music starts, the woman’s posture straightens, her stride improves, her arms swing in time, and she executes a pivot-turn, all movements she hadn’t seemed able to do moments before. Part of the improvement may be due to where the command to move is processed, Tomaino suggested. By
“letting music take over,” the patient may be dimming her conscious processing of a now-difficult maneuver and letting the brain automatically fill in the proper form. [more examples in a video by of the Institute for Music and Neurologic Function]
In therapy, “we bypass, believe it or not, fear,” Tomaino said. “When they stop their thinking about it, making it less conscious, their fluidity of movement comes back. It looks amazing, and it is. But this is so true with many people with Parkinson’s disease.”
It also can
help process language and speech. People with speech difficulties can improve their breath control by singing, and music’s rhythmic cues can help extend a person’s phrasing and access lost pockets of memory. Tomaino showed a video of a woman who could string together only three syllables at a time; after two months of twice-a-week training, she could speak 19 syllables at a time. “The motor timing, the contour and the timing of the singing, helped retrain the ability of speech,”Tomaino said. And the breath-control exercise helped her regain strength enough that doctors could remove her tracheal tube and she
could breathe on her own.
“I don’t think that everyone with aphasia is singing, but they should be," she said.