Take a little Yanni, and call me Bach

Music therapy is in wide use for chronic disease

The rehab room is anything but quiet. In one corner, a Parkinson’s patient is engaged in a lively drum duet with a therapist. Across the room, a woman who has had a stroke sways, waving her arms rhythmically to the beat of a Bach concerto her therapist is playing on an electronic keyboard. In an adjoining room, a young man with asthma plays a gentle air on a recorder.

And in a hospital half a dozen states away, a child with sickle cell anemia smiles at the guitarist by her side during a painful procedure. On another floor, in the intensive care unit, a cancer patient recovering from a painful surgery is lulled into a peaceful, healing slumber by the muted strains of "Amazing Grace," played by her therapist on the keyboard.

Music is a universal language to calm fears and to soothe pains. Increasingly, music therapy has found its way into the clinical setting as a way of addressing a host of illnesses and disease process — directly and through pain relief. Music therapists, board-certified graduates of one of 70 approved college and university music therapy programs, are found in hospitals, nursing homes, outpatient treatment centers, and a host of other medical and nonmedical settings throughout the country.

When was the last time you wrote "Bach" or "Beatles" on a prescription pad? Probably never. But proponents of music therapy want to remind you that music is powerful medicine.

Neurological disorders

"Music is of essential importance in understanding the brain and behavior," says Michael Thaut, PhD, professor of music and neuroscience at Colorado State University in Fort Collins. Thaut’s work with stroke and Alzheimer’s patients has produced maps of the cortical and subcortical areas of the brain that perceive rhythm and synchronize movement with rhythm. It has resulted in rhythmic entrainment to improve the gait of patients with stroke, Parkinson’s disease, cerebral palsy, and traumatic brain injury.

"We discovered about 10 years ago that the strong synchronization effect of rhythm on gait movements has a profound effect on the ability to walk," says Thaut. "In fact, rhythmic training has produced sustainable improvements for people with all of these types of neurological disorders," he adds.

In simple terms, Thaut says, rhythm helps retrain the nervous system. "It may begin with something as simple as moving arms to the music during some simple exercise. Then it can progress to walking, sitting down, and standing up." Think of a brass band playing marching music or a rock band thundering the bass at a steady pace. "It’s almost impossible not to stay in rhythm with the music. What we’re doing is taking a measured beat and using that same principal for neurological therapy," says Thaut.

Thaut has published several studies, including one on patients with traumatic brain injury.1 None had responded to traditional physical therapy, and all had passed the initial, three-month phase for spontaneous neurological recovery during which the most significant benefits usually occur. A key, he says, is that each patient’s velocity and rhythm was analyzed at the beginning of the process and specific metronome beats were inserted into music that was played while they walked every day for five weeks. Patients increased their walking speed by 50%, their cadence by 16%, and their stride length by 29% with the daily rhythmic auditory stimulation therapy. In practice, he says, similar results are obtained for patients with other neurological disorders. It’s important to coordinate the structure of the music and the movement, so Thaut and most of his colleagues favor live music. Some patients will be slower and others faster, or their ability to keep to the rhythm may diminish as they become fatigued. "We compose most of our own music because we have found that very specific rhythms work with very specific parts of the brain to help a patient execute movement in a coordinated way," Thaut adds.

Treating chronic pain

Pain is a factor in almost every chronic disease process, and music has a role in relieving that pain, says Joanne Loewy, DA, a music therapist at Beth Israel Hospital in New York City. Loewy has seen dramatic pain relief in adults and children with such painful conditions as sickle cell anemia, cancer, asthma, spinal pain, and pelvic inflammatory disease. "In some cases, music can be a distractor from the pain, but I think that music, especially live music, acts as an integrator," she says.

Loewy explains that live music helps a patient integrate the breath with the heart rate and the mind in the process of entraining. Music, coupled with an art exercise, also helps young patients communicate to health care professionals where the pain is and its intensity. "Let the music carry you on a journey away to a place where there is no pain. See where the pain is. Then draw where the pain is using these colors," Loewy says to the young patient with sickle cell anemia.

"Often we get new clues about the pain from this exercise," says Loewy. "The pain may be directly due to a physiological condition, but they may be holding emotional pain as well –- pain of trauma or sexual abuse — and this helps us identify it."

Music may, in its simplest form, help a patient relax the muscles and relieve pain through that simple release. Anxiety is always a component in chronic disease, but the benefits of music therapy may go beyond that.

Listen to the music of the individual

Loewy, who devotes a large portion of her work to children, says observing the child is an important way of understanding what he or she is feeling and thinking. "Observation is central to the act of understanding and feeling another being’s music of the body. By music, I am referring to a person’s rhythm of breath, patterns of speech, and pitch of sentences expressed, as well as the dance of his or her every movement. Each of us is a musical being, even without musical instruments," she says.

"If we listen carefully, we can feel the music of a person’s being," Loewy adds. For example, Loewy says, music can help a patients’ ability to void: "Drumming in particular has enhanced the flow and release of energy, beginning from the outside of the body and affecting movement and eventual release from inside the body. "As patients actively structure and control their own body’s ability to create rhythms for sustained periods, the body responds and rids itself of waste," she explains.

Specific instruments have specific effects on pain, keeping in mind that each person experiences pain differently and that some people hold their pain in and others want to release it, Loewy says. "For a person who wants to be nurtured, violin music is soothing and releasing. For a person who is angry about the pain, drumming might work better," she explains. "Music is also a wonderful way to help people transition from life to death," Loewy says.

Depending on patients’ ages, a favorite prayer or hymn might be used to calm anxieties and give them comfort, creating an atmosphere of safety. "I can watch the breath and the heart rate and the mood, and adjust the music as it is needed," she says. "We know at death, the last sense to go is the sense of hearing, so we can relieve the pain and anxiety with a song of comfort," Loewy adds.

Music’s effect on cardiovascular system

Several studies show music therapy is a tool that can address anxiety and discomfort associated with a variety of chronic diseases and hospitalization due to those illnesses. One Japanese study showed significant changes in natural killer (NK) cell activity in patients with Alzheimer’s disease, Parkinson’s disease, and cerebrovessel disease after a single music therapy session.2 The researchers wrote: "The results indicate that music therapy can significantly increase NK cell count and activity. The change in NK cell and function were independent of neurodegenerative diseases." Patients with heart disease and hypertension have benefited from music therapy as well.

Reducing blood pressure

An Israeli study shows that hypertensive patients given a home treatment device that combines slow, regular breathing using musical sound patterns for two months reduced systolic blood pressure by 15.2 mm Hg, diastolic pressure by 10.07 mm Hg, and mean arterial pressure (MAP) by 11.7 mm Hg. A control group that listened to quiet music with no particular beat inserted had smaller reductions: systolic 11.3, diastolic 5.6, and MAP 7.5.3

And finally, a study at Massachusetts General Hospital in Boston showed cardiac patients on bed rest because of invasive cardiac procedures responded to a single 30-minute music therapy session with reduced blood pressure, respiratory rate, and psychological distress.4

"Some people may think we just play music and people relax and that’s the end of it," says Thaut. "Our research is not anecdotal. It’s conducted in a scientific manner and the results are verifiable."

[For more information, contact:

The American Music Therapy Association, 8455 Colesville Road, Suite 1000, Silver Spring, MD 20910. Telephone: (301) 589-3300. Web site: www.musictherapy.org.]

References

1. Hurt CP, Rice RR, McIntosh GC, et al. Rhythmic auditory stimulation in gait training for patients with traumatic brain injury. J Music Ther 1998; 35:228-241.

2. Hasegawa Y, Kubota N, Inagaki I. Music therapy induced alterations in natural killer cell count and function. Nippon Ronen Igakkai Zasshi 2001; 38:201-204.

3. Schein MH, Gavish B, Herz M. Treating hypertension with a device that slows and regularizes breathing: A randomized, double-blind controlled study. J Hum Hypertens 2001; 15:271-278.

4. Cadigan ME, Caruso NA, Haldeman SM, et al. The effects of music on cardiac patients on bed rest. Prog Cardiovasc Nurs 2001; 16:5-13.