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Music to Minimize Maladies
8:32 AM: Now I am really, completely awake.
9:07 AM: Now I am perfectly, overwhelmingly awake.
9:35 AM: Now I am superlatively, actually awake.
This is a typical entry from the dreadful journal of Clive Wearing. Clive has a memory span of seven seconds. His wife Deborah accurately describes his plight, recounting that “it [is] as if every waking moment [is] the first waking moment. Clive [is] under the constant impression that he ha[s] just emerged from unconsciousness because he ha[s] no evidence in his own mind of ever being awake before” (Wearing). Having the worst case of retrograde amnesia ever recorded in the world, Clive has lost all memory of his past and the ability to ever remember anything ever again. He is a being without a past to reminisce over or a future to look forward to. He is imprisoned in an isolated, chaotic, and meaningless present. Each time his eyes blink, the world and scene in front of him appears brand new, completely unprecedented, as his amnesia instantly sucks out all images and remembrances of the past into a black hole.
But there is one glimmer of hope through which Clive can experience a sense of his life before the on struck of his amnesia. There is one passion through which Clive can escape the torture and pain of his present condition and enter a state of bliss, control, and complete freedom. This is through music. Miraculously, Clive’s musical abilities have been left untouched by his amnesia. He can read music, play piano, sing opera, and improvise with great emotion and passion. Whenever Clive plays music, his face lights up into a joyous smile and all traces of distress from his amnesia instantly evaporate, so that Clive resembles his former healthy self. Music is Clive’s one and only life line and savior.
Since the birth of mankind, music has played an integral part in human society. Each and every culture, even in the remotest parts of the world today, has music of some shape or form. Music, through its beautiful melodies, compelling rhythms, and emotional touch, holds a key place in the hearts of man. Furthermore, music, through its incredible complexity and vastness, exerts deep and powerful effects on the human mind. The study of the connection between music and the brain has recently exploded in the past two decades as neuroscientists, musicians, doctors, and therapists have come together to unravel the true potential of music in healing many ailments. After considerable study and experimentation, music therapy has proven to have profound therapeutic potential in treating many neurological disorders such as atrophied limbs, Parkinsonism, and Aphasia after a stroke. Thus, it should be more widely implemented in clinics and hospitals.
The rhythmic quality of music effectively provides a bridge from auditory systems in the brain to motor systems that control movement. Due to this fascinating connection, neuroscientists have found that music can restore function to atrophied body parts in ways that modern medicines and surgeries have failed to accomplish. Music is uniquely powerful in that it activates many different parts of the brain, far more than most other daily activities such as speaking or doing math. Functional brain imaging has shown that when humans naturally react and move to the beats in a piece of music (such as tapping one’s foot to the rhythm of a song), the motor cortex and subcortical systems in the basal ganglia and cerebellum are activated. The basal ganglia, a group of nuclei in the brain, are involved in a variety of functions, including voluntary motor control, procedural learning, and emotional functions. Dr. Aniruddh Patel of the Neurosciences Institute has explained that one of the reasons we move to the beats in music naturally is because the basal ganglia are involved in both interval timing and in motor control. Humans are quiet unique in this natural response to move to beats. For example, rats have basil ganglia too, but only humans move to a beat (Patel). The Cerebellum is a region of the brain that plays an important role in motor control. Rather than initiating movement, the cerebellum assists in coordination, precision, and accurate timing. It receives input from sensory systems and other parts of the brain and then uses the received information to fine tune motor activity.
Research has also shown that simply imagining music activates motor cortex and subcortical motor systems in the same way that actually listening to music does. The human brain is unique in that there exists a functional connection between the auditory and dorsal premotor cortex. Keeping time to music depends on interactions between these two systems.
Knowing all this, one can easily guess that rhythm, with its combination of sound and movement, can play a great role in coordinating and animating movement. This brings us back to how music can help restore atrophied body parts. Atrophied body parts can be viewed as parts of the body that do not necessarily have a problem, but that are hard to move or seem paralyzed. For example, if a person becomes injured from an accident such as a fracture, he or she may become bed-ridden for a long period of time and thus not walk for weeks together. In some cases, people with this kind of situation may almost forget how to walk or stand after weeks of not engaging in such activity. There will be deactivation not only in nerve elements of damaged muscles but also “centrally in the ‘body image’, the mapping or representation of the body in the brain” (Sacks 257). The damaged body part may then lose its place in the brain’s body image while the rest of the body’s representation expands to fill the gap. In simpler terms, after a long period of disuse of a certain part of the body, the brain may “forget” that this specific body part exists. Once this occurs, the body part will seem functionless to the brain. Moving such a body part may prove to be very difficult. In such a situation, another source must be brought in to “kick start a damaged or inhibited motor system into action again” (Sacks 257). Music above all else seems the most capable for this job.
Dr. Oliver Sacks of Columbia University describes the way in which he cured one patient’s atrophied left leg by utilizing Irish jigs. The patient came to him complaining of a paralyzed and useless left leg. She had suffered a complex hip fracture, and then underwent a surgery, followed by many weeks of immobility in a cast. Although the surgery had been successful, the lady found her leg to be inert and useless, although no anatomical or neurological reason accounted for this. The patient did point out however that her leg had once moved on its own to the rhythm of an Irish jig. This thus proved to Dr. Sacks that music could act as the perfect activator and de-inhibitor for the atrophied leg. After months of carefully exposing the lady to Irish dance tunes, the lady finally reclaimed her leg and delighted in the fact that she could once again walk normally and voluntarily move her left leg (256).
The remarkable capacity of music does not stop here however. Listening to music can help organize and smoothen the jerky and coarse movements of one with Parkinson’s disease. Parkinson’s disease is a progressive degenerative disorder of the central nervous system in which a person’s movements are mainly affected in the early stages of the disease. Cognitive and behavioral problems such as dementia usually occur in the advanced stages of the disease. Parkinson’s disease also partly occurs from insufficient formation and activity of dopamine produced in certain neurons of parts of the brain.
Dopamine functions as a neurotransmitter and gets released during times of great pleasure, due to its major role of reward sensory in the brain. Recent experiments have shown that hearing music often stimulates the release of dopamine. After thorough experimentation, professor Robert Zatorre and others concluded that “intense pleasure in response to music can lead to dopamine release in the striatal system,” which thus “help[s] to explain why music is of such high value across all human societies” (Zatorre). Recalling that a lack of dopamine partially causes Parkinsonism, one can clearly see why music is an extremely viable treatment for this disease.
Those with Parkinson’s disease lack a smooth flow of movement and suffer from brokenness, jerkiness, and gaps in their motions. Fortunately, this “Parkinsonian stutter” responds amazingly to rhythm and the flow of music (Sacks 274). Typically, legato music with a well defined, but not intrusive, rhythm works best to treat Parkinsonian patients. Music’s role in Parkinsonism is also unique in that no special music therapist or nurse is required. Simply listening to a piece of music with on a CD player or IPod brings out the desired results. In addition, the music that patients listen to does not need to be familiar or even enjoyable to the patient in order to work, though this often helps the process.
Though the patient is usually unaware of this disparity, the movements and perceptions of people with Parkinson’s disease are usually either too slow or too fast. This problem can be viewed as a difference between personal time and clock time. If music is present however, “its tempo and speed take precedence over Parkinsonism and allow Parkinsonian patients to return, while the music lasts, to their natural rate of moving before illness” (Sacks 276). Music simply imposes its inherent tempo on the afflicted patient without slowing down or speeding up. Music provides a continuous stream of stimulation with clear rhythmic organization that mimics the automaticity and fluency of true walking. Professor Michael Thaut, a pioneer in the use of rhythmic auditory stimulation to facilitate walking in patients with Parkinsonism, has performed numerous experiments on music’s effects on the gait patterns of patients with Parkinson’s disease and has suggested “techniques for gait rehabilitation” (Thaut).
The inability to initiate movement spontaneously though has also proven to be one major issue in Parkinson’s disease. Dr. Sacks describes his patients as “always getting stuck or frozen” (Sacks 277). In normal individuals with healthy basal ganglia, an immediate connection between people’s intentions and subcortical machinery exists that allows for the automatic action of these intentions. On the other hand, Parkinsonian patients with severely damaged basal ganglia are usually reduced to constant immobility and silence. These people are unable to initiate any movement alone, but respond well to, and emerge from their virtual isolation, with the aid of an outside stimulus. For these patients, a long and continuous release is needed. Thus, music once again proves to the ideal external stimulus.
Dr. Oliver Sacks provides a clear example of this as he describes the post encephalitic patient Rosalie in his novel Musicophilia. He describes that Rosalie “tended to remain transfixed for hours each day, completely motionless, frozen-usually with one finger ‘stuck’ to her spectacles”. Once she sat in the piano bench however, her “stuck” hand would instantly come down to the keyboard as she played with ease and fluency. Her usually frozen, inexpressive, Parkinsonian face would be full of expression and feeling. At times like this, her EEG reading would also be normal. Music, though for only small periods of time, truly liberated Rosalie from Parkinsonism (Sacks 278).
Apart from rhythmically treating movement, the melody of music contains compelling effects on speech and can thus be used to help restore speech after a it is lost from a stroke. Aphasia can be described as language impairment that causes normally intelligent patients to have very limited and exerting verbal outputs. Aphasics know what they want to say, but remain helpless in expressing themselves. One remarkable observation, however, has been that many people with aphasia usually posses the capability to sing songs with words.
Speech and music have many characteristics such as inflections, intonation, tempo, rhythm, and melody in common. Although both depend on parts of the brain dedicated to analyzing complex strings of sound, each is represented differently in the brain. Due to this, music can greatly aid in restoring the broken speech of those with aphasia.
Music has the great mnemonic ability of embedding lots of information into small musical songs. Many of us use such musical mnemonics to memorize information, such as the days of the week in Spanish or the quadratic equation in Algebra. People with aphasia also posses this ability to learn and recite such mnemonics, thus allowing them to say strings of words at a time.
In 1947, neuropsychologist Alexander Luria studied the impacts of stroke and proposed that that there are two levels of damage after a stroke. The core level of damage destroys tissue and thus proves irreversible. The second level affects surrounding areas and may depress and inhibit certain functions. This sort of damage may be reversible (Sacks 237).
After a stroke, if the secondary inhibition damage does not go away on its own, therapy must be used. Speech therapy can de-inhibit impaired speech after stroke, but fails much of the time. Music therapy can instead be implemented to work in ways that speech therapy cannot. (Sacks 239).
Dr. Aniruddh Patel, in his essay on the biological use of music, describes one form of musical aphasia therapy known as melodic intonation therapy (MIT). MIT “embeds short phrases in ‘melodic’ speech intonation patterns. Patients practice such utterances intensively and regularly with a therapist, who gradually lengthens the phrases to span more syllables” (Patel). In other words, certain vocal phrases are set to music so aphasics can sing them. Gradually, the musical elements are removed until a patient can speak without the assistance of music.
Why MIT works can be explained by the findings of neuroscientists in the 1990’s, which Dr. Sacks nicely explains in the novel “Musicophilia”. PET scans by Pascal Belin in 1996 showed that there was not only an inhibition of Broca’s area (the left hemisphere part of the brain responsible for language production) in aphasic patients, but also hyperactivity of a homologous area in right hemisphere ( the“right Brocas area”). The hyperactivity of the right hemisphere seemed to be inhibiting the “good” Broca’s area, which, in its weakened state, was powerless to resist. From this, neuroscientists realized that they had to not only stimulate the normal left Broca’s area but also damp down the malignant hyperactivity of the right. Singing and MIT do exactly this. By engaging right hemisphere circuits in normal activity, they disengage them from harmful activity. Once the left Broca’s area is released from inhibition, it can exert a suppressant action on right Broca’s area. This therapeutic cycle can help restore speech (Sacks 240).
It is important to also note the various forms of music therapy. While Parkinson’s disease can be tackled by simply listening to recorded music on an IPod, Aphasia music therapy requires a sustained relationship between a live music therapist and the patient. Furthermore, it is not imperative that music used to treat aphasia has a distinct beat or rhythm.
The extraordinary power music has over humans can be productively harnessed through the use of music therapy. No matter what race, gender, age, or religion a person is, music has the same compelling and mystical effects on his mind. The treatment of muscle atrophy, Parkinsonism, and Aphasia are just a few of the numerous ways music can heal us. Serious research of music and the mind only began very recently, at the end of the 20th century. Thus, at this point in time, music has not yet found its way into many doctor’s offices and hospital wards. Music has the power to treat us in ways far beyond the realm of medicines and surgeries. For the benefit of the human species, it is imperative that music therapy becomes a part of the medical world, working in harmony with the medical tools have in place already. The next time someone goes to the doctor with a malady, there should be a possibility that their prescription reads, “Music Therapy.”
Fick, Steven, and Elizabeth Shilts. "This is your brain on music." À LA CARTE Jan 2006: n. pag. Web. 24 Feb 2011.
Hopkin, Karen. "Musical Chills Related to Brain Dopamine Release." Scientific American 11 Jan 2011: n. pag. Web. 23 Feb 2011.
Levitin, Daniel. This is Your Brain on Music. New York, NY: Penguin Group (USA) Inc., 2006. Print.
Patel, Aniruddh. "Music, biological evolution, and the brain." Emerging Disciplines. (2010): Print.
Sacks, Oliver. Musicophilia. New York, NY: Random House, Inc., 2008. Print. (Sacks)
Thaut, Michael. "Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson's disease." Journal of Neurology, Neurosurgery, and Psychiatry. 62.1 (1997): Print. (Thaut)
Wearing, Deborah. Forever Today. New York, NY: Random House, 2004. Print.
Zatorre, Robert. "Anatomically distinct dopamine release during anticipation and experience of peak emotion to music." Nature Neuroscience (2010): n. pag. Web. 25 Feb 2011.