CREATIVE AGILITY: HOW TO INSPIRE REAL INNOVATION page 54 IS MIDLIFE CRISIS REAL? THE TRUTH—AND HOW TO DEAL WITH IT BEHAVIOR • BRAIN SCIENCE • INSIGHTS page 58 MMarch/April 2015 IND Mind.Scienti cAmerican.com “OF COURSE, HOWHOW I COULD DIE” MUSICMUSIC STANDING UP HEALSHEALS TO EBOLA CAT QUALM THETHE PROBLEMS FROM A BRAINBRAIN PARASITE? ITS POWER FIRST AID TO LIFT MOOD FOR MENTAL AND BUILD HEALTH CONNECTIONS © 2015 Scientific American 32 SCIENTIFIC AMERICAN MIND MarcH/APRIL 2015 © 2015 SCIENTIFIC AMERICAN The Healing Power Musof c New therapies are using rhythm, beat and melodyi to help patients with brain disorders recover language, hearing, motion and emotion By William Forde Thompson and Gottfried Schlaug ILLUSTRATIONS BY CHRISSIE MACDONALD One day when Laurel was 11, she began to feel dizzy while playing with her twin sister and some friends in a park on Cape Cod. She sat down, and one of her friends asked her if she was okay. And then Laurel’s memory went blank. A sudden blockage in a key blood vessel leading to the brain had caused a massive stroke. Blood could no longer reach regions crucial for lan- guage and communication, resulting in permanent Odamage. Laurel was still able to understand language, but she struggled to vocalize even a single word, and what she managed to say was often garbled or not what she had intended. MIND.SCIENTIFICAMERICAN.COM SCIENTIFIC AMERICAN MIND 33 © 2015 SCIENTIFIC AMERICAN Except when she sang. Through a type of treatment called melodic intonation lennium b.c. appear to depict the use of music to enhance therapy, Laurel learned to draw on undamaged brain regions fertility in women. Shamans in the highland tropical forests that moderate the rhythmic and tonal aspects of language, by- of Peru use chanting as their primary tool for healing, and passing the speech pathways on the left side of her brain that the Ashanti people of Ghana accompany healing ceremonies were destroyed. In other words, she found her way back to lan- with drumming. guage through music. Much of the power of music-based treatment lies in its The therapeutic program that helped Laurel—like the oth- ability to meld numerous subtle benefi ts in a single, engaging ers we focus on in our work as scientists and clinicians—is one package [ see boxes beginning on this page ]. Music is perhaps of a new class of music-based treatments based directly on the unrivaled by any other form of human expression in the range biology of neurological impairment and recovery. These treat- ments aim to restore functions lost to injury or neurological disorders by enlisting healthy areas of the brain and sometimes even by reviving dysfunctional circuitry. As evidence accumu- lates about the effectiveness of these techniques, clinicians and MUSICAL ATTRIBUTES therapists from a variety of fi elds have begun to incorporate a uniquely effective tool them into their practices, most notably music therapists, who Music is are at the intersection of music and health and important for treating neurological impairment mediators of these interventions, as well as speech therapists because it recruits nearly every and physical therapists. And among the benefi ciaries are peo- region of the brain. Imaging studies ple diagnosed with stroke, autism, tinnitus, Parkinson’s dis- show that both listening to and ease and dementia. making music spur activity and foster As scientists learn more about the effect of music on cogni- connections across a wide swath of tive and motor functions and mental states, they can tailor these therapies for each disorder, targeting specifi c brain inju- brain regions typically involved in ries or dysfunctions. In Laurel’s case, the treatments were de- emotion, reward, cognition, sensation signed to trigger, over time, the development of alternative neu- and movement. Here are seven ways ral pathways in healthy parts of the brain that would compen- music might work to benefi t our mind sate for the lost pathways in the damaged language centers. But and brain: the ultimate aim was to help her recapture as much as she could of the world that had collapsed around her that day in the park. Music as Medicine Across cultures and throughout history, music listening and music making have played a role in treating disorders of of its defi ning characteristics, from its melody and rhythm to the mind and body. Egyptian frescoes from the fourth mil- its emotional and social nature. The treatments that take ad- vantage of these attributes are rewarding, motivating, acces- sible and inexpensive, and basically free of side effects, too. FAST FACTS The attractive quality of music also encourages patients to MUSICAL PRESCRIPTIONS continue therapy over many weeks and months, improving Music can be a powerful tool in the treatment of brain disorders the chance of lasting gains. and acquired injuries, helping patients recover language and The view that music can be useful in treating neurological motor skills. impairment gained some scientifi c heft in a landmark study New music-based therapies can trigger neuroplasticity—fostering local connections and long-range pathways that compensate for published in 2008. Psychologist Teppo Särkämö of the Univer- impairments in damaged regions of the brain. sity of Helsinki and his team recruited 60 patients who had suf- The greatest benefi ts from therapy—cognitive, emotional and fered a stroke in the middle cerebral artery of one hemisphere. social—come from effortful engagement with music. They split the patients into three groups: the fi rst participated 34 SCIENTIFIC AMERICAN MIND MARCH/APRIL 2015 © 2015 SCIENTIFIC AMERICAN © 2015 SCIENTIFIC AMERICAN Music is Physical Music encourages people to move with the beat. The more Images show the arcuate fasciculus, an auditory-motor tract, salient the beat, the in each hemisphere of a healthy musician (left) and a healthy non musician, both in their early 60s, demonstrating the brain- more sweeping and enhancing benefi ts of lifelong music making. emphatic the body movements. Physical exercise can help improve circulation, brain health, and fi ne stressed syllable (“are”) assigned a higher pitch than the oth- and gross motor function. ers. As the treatment progresses, the phrases get longer and the frequency of the vocalizations increases, perhaps from one syllable per second to two. Each element of the treatment contributes to fl uency by re- in daily sessions of music listening, the second listened to au- cruiting undamaged areas of the brain. The slow changes in diobooks every day and the third received no auditory treat- the pitch of the voice engage areas associated with perception ment. Researchers observed the patients over two months. in the right hemisphere, which integrates sensory information Those in the group that listened to music exhibited the great- over a longer interval than the left hemisphere does; as a con- est recovery in verbal memory and attention. And because lis- sequence, it is particularly sensitive to slowly modulated tening to music appears to improve memory, the hope now is sounds. The rhythmic tapping with the left hand, in turn, in- that active music making—singing, moving and synchronizing vokes a network in the right hemisphere that controls move- to a beat—might help restore additional skills, including speech ments associated with the vocal apparatus. Benefi ts are often and motor functions in stroke patients. evident after even a single treatment session. But when per- formed intensively over months, melodic intonation therapy The Singing Cure also produces long-term gains that appear to arise from chang- The variety of music-based treatment that Laurel received es in neural circuitry—the creation of alternative pathways or springs from a remarkable observation about people who the strengthening of rudimentary ones in the brain. In effect, VOL. 16, NO. OCTOBER 5; 2010 have had a stroke. When a stroke affects areas of the brain that control speech, it can leave patients with a condition known as nonfl uent aphasia, or an inability to speak fl uent- ly. And yet, as therapists over the years have noted, people Music is with nonfl uent aphasia can sometimes sing words they can- NEUROSCIENTIST, not otherwise say. Emotional In the 1970s neurologist Martin Albert and speech pa- Music induces thologists Robert Sparks and Nancy Helm (now Helm-Esta- emotional states by brooks), then at a Veterans Administration hospital in Bos- initiating changes in ton, recognized the therapeutic implications of this ability the distribution of and developed a treatment called melodic intonation thera- neurochemicals that py in which singing is a central element. During a typical ses- sion, patients will sing words and short phrases set to a sim- can induce positive ple melody while tapping out each syllable with their left moods and heightened arousal, which hand. The melody usually involves two notes, perhaps sepa- may in turn increase the rate of change rated by a minor third (such as the first two notes of in the brain, speeding rehabilitation. “Greensleeves”). For example, patients might sing the phrase FROM “MUSIC MAKING AS A TOOL FOR PROMOTING BRAIN PLASTICITY ACROSSBY CATHERINE THE WAN LIFE AND Y. GOTTFRIED SPAN,” SCHLAUG, IN “How are you?” in a simple up-and-down pattern, with the MIND.SCIENTIFICAMERICAN.COM SCIENTIFIC AMERICAN MIND 35 © 2015 SCIENTIFIC AMERICAN for patients with severe aphasia, singing trains structures and Because melodic intonation therapy seemed to work by en- connections in the brain’s right hemisphere to assume perma- gaging the right hemisphere, researchers then surmised that nent responsibility for a task usually handled mostly by the left. electrical or magnetic stimulation of the region might boost the This theory has gained support in the past two decades from therapy’s power. In two recent studies that we conducted with studies of stroke patients with nonfl uent aphasia conducted by our collaborators—one in 2011 at Beth Israel Deaconess and researchers around the world.