Charlotte Gordon, Audiologist at Phonak NZ

Music to your brain

Hearing and music are inextricably intertwined. Learn about research out of New Zealand showing music therapy to be beneficial for those with neurological disorders.

Music is a universal language that underpins the fabric of gatherings, celebrations, and milestones in all societies (think ‘Happy Birthday’). Music is powerful in the way that it can elicit various emotions; it can be rewarding, comforting and satisfying. Music begets a feeling of connectedness even in a room full of strangers. It can also be a powerful tool to help those (and their families) who are suffering from various brain injuries and disorders that affect sensory and motor skills.1 For example, Alzheimer’s Disease2, Parkinson’s Disease3,4, Stroke5, and Autism.6

Lady Rhyl Jansen and Alison Talmage from the Kahikatea Music Therapy and Community Arts Trust understand the importance of music therapy, especially for individuals and their families who are living with neurodegenerative disorders. I recently caught up with them to find out how they help to improve quality of life for these communities, through the power of music.

Alison, who is a music therapist and PhD candidate in this area, explains that music therapy uses a biopsychosocial-spiritual approach that looks at the whole person, rather than purely at the clinical manifestations of the disorder. Through the creation of music it is often possible to address several areas of well-being concurrently.

Alison, who started the Trust has also led the CeleBration Choir for the last 11 years. This is an initiative at the Centre of Brain Research at the University of Auckland. Alison says, “In music therapy we tend to talk about ’approaches’ rather than ‘treatments’ – but this varies, depending on the orientation of the individual music therapist and organization.”

Lady Rhyl has personal experience with music therapy. She joined the CeleBRation Choir when her late husband Sir Ross Jansen, was diagnosed with primary progressive aphasia. She found that participation in the choir significantly improved quality of life for both of them. Because of the significant benefit Lady Rhyl found in joining the CeleBration choir, she was immediately keen to support Alison in establishing a trust for music therapy.

The trust chose the name ‘Kahikatea’ which is a native tree in New Zealand/Aotearoa as like many trees in Aotearoa, has no tap root which means the roots of neighboring trees must intertwine to support each other. This is a powerful image and one that reflects the community that Lady Rhyl and Alison are working hard to build by enabling those affected by neurodegenerative disorders and their families to come together through music. Watch this video here to learn more.

What does this have to do with hearing? Well, everything. Hearing and music are inextricably intertwined. Through hearing well, we remain connected to the people around us. We also remain connected to the sounds we love, whether it be nature or music, this means we are able to appreciate and process these sounds and be an active part of our environment and community.

Briefly, how do we process sound?

Assimilating and making sense of sound is a very computationally challenging task for our brains because we need to process information in microseconds.5 When there is a healthy auditory system and brain, there is a high fidelity relay of sound from when it enters the ear to where it is processed at the level of the auditory cortex. The important aspects of sound are rooted in volume, loudness, pitch, temporal cues and timbre. Multiple networks combine to compute, assimilate and create a response to the sound (the detail of which are beyond the scope of this blog). Music stimulation also activates and engages widely distributed networks that are not specifically ‘music processing networks’ but overlap with regions involved in cognitive, motor and language function.6 This multi-region activation is thought to play a big role in music therapy.

How is it that music helps a diseased brain?

It is not a foreign concept that music can aid neural changes – we know that music supports the development of listening and literacy skills in children with hearing loss (see a previous blog article by Dr. Carol Flexer here), but what are the purported mechanisms behind music therapy in adults with brain injury or disease?

Because music activates multiple areas of the brain, if one region is damaged or not functioning well, people can often still respond to music. For those with neurodegenerative disorders where movement is affected (for example, stroke and Parkinson’s ), music therapy has shown to significantly improve gait (the movement required to walk). Music offers rhythm, which has an external pulse. It is thought this perceived rhythm primes the motor system which helps to initiate and pace movement.9,10 Music has also been shown to improve vocalizations in those whose speech has been affected in neurological conditions. This is because sung language uses a different pathway to access Broca’s area (an area of the brain linked to speech production) which then aids in rehabilitating language function.11,12

For patients who have dementia, music has shown to improve mood and increase executive memory through the reduction of anxiety, depression, irritability and agitation.13 Interestingly, musical memory is often preserved in patients with dementia, this is because musical memory is partially independent on other memory systems and in dementia, music memory is thought to be somewhat spared.14 Studies have shown that music training in dementia patients results in increased neural activities, neural efficacy and cognition, which can result in increased neuroplasticity.15,16 Further, studies have also suggested that music promotes several neurotransmitters, neuropeptides, and other biochemical mediators to be released.17 This includes endorphins, endocannabinoids, dopamine and nitric oxide – all components that contribute to an overall feeling of relaxation and happiness.

Music therapy also helps significant others and carers

Not only does music therapy have a significant positive impact for those suffering from neurological disorders or injury, it significantly benefits those caring for them too. Singing together can provide a meaningful activity for the patient and their carer and also provide a respite for the carer. Research at the University of Auckland found a higher than expected self-reported Quality of Life (measured using WHOQOL-BREV) for participants in “neurological choirs” (a NZ term for choirs and singing groups for people living with a neurological condition) – probably due to the social context and shared enjoyment of singing (as a preferred activity).18 This is also particularly relevant during the pandemic – a collective trauma that has particularly impacted older people and those with underlying health conditions.

Alison says: “Music is enjoyable and motivating for many people – an acceptable activity to address multiple domains. While we can use the elements of music (e.g. pitch, rhythm, repetition, lyrics, timbre, loudness) and a person’s preferred musical genre to address specific goals (psychosocial, physical, communication, spiritual), it doesn’t feel like “treatment” so people will often engage more readily.”

Conclusion

Music therapy is beneficial to those with neurodegenerative disorders and their family members, through shared music-making in a strengths-based, social context. Not dissimilar to hearing-well, music builds connectedness, a feeling of belonging and ultimately a sense of well-being. Go put on a good tune, dance like no one is watching – you might find yourself in a better mood 😊


Three key takeaways

  • Music therapy has significant benefits for those suffering from acquired neurological disorders or damage and their carers
  • Like hearing well, music therapy can bring about a feeling of connectedness and improve overall well-being.
  • If you have any patients or clients who have co-morbidities including hearing loss ensure they can hear well so that they can benefit from the powerful properties of hearing well and music.

Watch more on music therapy in the video below.

References

  1. Purdy, S.C. (2020). Communication in the context of te whare tapa whā model of health. International Journal of Speech-Language Pathology, 22(3), 281-289.
  2. Guetin, S. et al. (2013). An overview of the use of music therapy in the context of Alzheimer’s disease: a report of a French expert group. Dementia (London, England), 12,5 619-34. doi:10.1177/1471301212438290
  3. Eri Haneishi, M.M.E. (2001). Effects of a music therapy Voice Protocol on speech intelligibility, vocal acoustic measures, and mood of individuals with Parkinson’s Disease, Journal of Music Therapy, 38(4) , 273–290. https://doi.org/10.1093/jmt/38.4.273
  4. Murgia M., Corona, F., Pili, R., Sors, F., Agostini, T., Casula, C., et al. (2014). Rehabilitation. Curr Phys Med Rehabil Rep, 2106–113. https://doi.org/10.1007/s40141-014-0049-y
  5. Wigram, T. & Gold, C. (2006). “Music therapy in the assessment and treatment of autistic spectrum disorder: clinical application and research evidence.” Child: care, health and development, 32 5 535-42 .
  6. Kraus. N. (2015, December 14). How music, language shape the brain. ScienceDaily. Northwestern University. Retrieved October 23, 2020 from www.sciencedaily.com/releases/2015/12/151214185800.htm
  7. Koelsch, S., (2011). Towards a neural basis of music perception – a review and updated model. Frontiers in Psychology, 2(119).
  8. Thaut, M.H. & Hoemberg, V. (2014). Handbook of Neurologic Music Therapy. Oxford: Oxford University Press,
  9. Schlaug, G., Marchina, S., & Norton, A. (2008). From singing to speaking: why singing may lead to recovery of expressive language function in patients with Broca’s aphasia. Music Percept. 25:315–23. doi: 10.1525/mp.2008.25.4.315
  10. Clements-Cortes, A., & Bartel, L., (2018). Are we doing more than we know? Possible mechanisms in response to music therapy. Frontiers in Medicine. https://doi.org/10.3389/fmed.2018.00255
  11. Schlaug, G., Marchina, S., & Norton, A. (2009). Evidence for plasticity in white-matter tracts of patients with chronic broca’s aphasia undergoing intense intonation-based speech therapy. Ann N Y Acad Sci. 1169:385–94. doi: 10.1111/j.1749-6632.2009.04587.x
  12. Gómez Gallego, M., & Gómez García, J. (2016). Music therapy and Alzheimer’s disease: cognitive, psychological, and behavioural effects. Neurologia.
  13. Moreira, S.V., Justi, F.R.R., & Morira, M., (2018). Can musical intervention improve memory improve memory in Alzheimer’s patients? Dement Neuroopsychol, 12(2):133-142.
  14. Herholz, S.C., Herholz, R.S., & Herholz, K. (2013). Non-pharmacological interventions and neuroplasticity in early stage Alzheimer’s disease. Expert Rev Neurother, 13:1235–45. doi: 10.1586/14737175.2013.845086.
  15. Satoh, M., Yuba, T., Tabei, K., Okubo, Y., Kida, H., Sakuma, H., et al. (2015). Music therapy using singing training improves psychomotor speed in patients with Alzheimer’s disease: a neuropsychological and fMRI study. Dement Geriatr Cogn Dis Extra, 5:296–308. doi: 10.1159/000436960
  16. Boso, M., Politi, P., Barale, F., & Enzo, E. (2006). Neurophysiology and neurobiology of the musical experience. Funct Neurol, 21:187–91. [PubMed] [Google Scholar]
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