The Herd

How Music Can Help an Incurable Disease

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The author, Jason Albaum, checks that the volume of Phyllis’s music isn’t too loud or too quiet. Phyllis’s playlist contains the upbeat marches of John Phillips Souza, Big Band classics like “In The Mood,” and, of course, “Take Me Out to the Ballgame.”

Photo: Scott Ellis

The author, Jason Albaum, checks that the volume of Phyllis’s music isn’t too loud or too quiet. Phyllis’s playlist contains the upbeat marches of John Phillips Souza, Big Band classics like “In The Mood,” and, of course, “Take Me Out to the Ballgame.” Photo: Scott Ellis

The author, Jason Albaum, checks that the volume of Phyllis’s music isn’t too loud or too quiet. Phyllis’s playlist contains the upbeat marches of John Phillips Souza, Big Band classics like “In The Mood,” and, of course, “Take Me Out to the Ballgame.” Photo: Scott Ellis

Jason Albaum, Guest Writer

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It was a September Friday afternoon and school had just been dismissed. Two of my closest classmates, Colby and Juli, awaited my arrival in the high school lobby. While other students drove home, we walked along Fletcher Street, fall colors overhead, toward the Kennebunk Center for Health and Rehabilitation. Upon entering, we were greeted by the usual folks: Lorraine perched on the couch with her cane across her lap, Bill lounging by the window with his oxygen tank, Dottie trying to escape through the open door behind us. We have developed personal connections with these residents, and several others, throughout our weekly visits. It’s like visiting a house full of wonderful grandparents. Our common passion for music has enabled us to form these intergenerational connections.

We’ve been practicing this Friday ritual for the past three years, beginning in middle school. During eighth grade, our teachers introduced us to the Community Service Project. We were challenged to form small groups based on a shared interest, identify a related problem in our community, and develop a plan to resolve that issue. Colby, Juli, and I were not quick to produce any viable ideas, despite being eager young musicians. How could our musical interests help the community? Our expertise in multiple choice tests didn’t help, since the answers weren’t in front of us. Eventually, we refined our plan, and what started as a school project became something much more.

Our group, Project Playback, provides music therapy to the elderly. With community-donated iPods, we create personalized music playlists for the residents. Each resident’s playlist is as unique as their identity, compiled through questionnaires sent to facility staff and the resident’s family. Our goal is to transport elderly residents back to their youth and encourage joyful, cross-generational interactions–whether it is dancing, singing, or simple conversation. Project Playback focuses on providing therapy to residents suffering from Alzheimer’s and dementia. Music is incredibly beneficial for the lives of these people, which we’ve experienced personally, visit after visit. Our interaction with Phyllis embodies this. Phyllis is a quiet woman. She is typically nonverbal and withdrawn from her surroundings. Nonetheless, Phyllis is one of the sweetest ladies that I have ever met. I am graced by her smile, a gentle rising from the corners of her mouth, each week. The photos on her room walls capture that smile. One shows her seated at the foot of a staircase, with owl-like glasses set on her nose. She smiles broadly as a cat nestles in her lap. Another portrait shows Phyllis beaming with joy next to her husband. That smile is faint in the woman I see before me, confined to her wheelchair, virtually unable to communicate. Alzheimer’s has taken that joy away from her.

We had long been told that Phyllis was a lifelong Red Sox fan. That September Friday afternoon, we decided to try something new. Phyllis had never spoken to us before, but we wondered if she would sing along to “Take Me Out to the Ballgame.” We wheeled Phyllis to her room after lunch and sat circled around her. On her iPod, we selected the song, adjusted the volume, and soon enough, she began singing. Her voice was airy and frail and virtually unused. We repeated the song. With bright eyes and an even brighter smile, Phyllis continued to sing with us. After the third time, we paused the music. “Phyllis,” I asked, “were you a big Red Sox fan back in your day?” In response, she was the most vocal we had ever seen her, even surprising the staff. Phyllis told us about watching baseball games in the living room when she was young. She told us about playing baseball in the backyard with her brothers. She told us that she loved those memories. In that brief moment, our circle of four temporarily overcame the incurable disease of Alzheimer’s.

Alzheimer’s is a debilitating cognitive disease mainly affecting the elderly. It reduces cognitive and behavioral functioning enough to disrupt daily life, a result of fibrous plaques and tangles that clump and block neural pathways (“Alzheimer’s Disease…”). The symptoms of Alzheimer’s worsen as more plaques and tangles develop. Short term memory is impaired first, followed by logical thinking and emotional processing skills. Patients with more severe cases experience paranoia, hallucinations, and long term memory loss that deactivates their self-awareness and recognition of familiar people like family members. The final stage of Alzheimer’s affects the brain’s ability to monitor heart rate, breathing, and nutrient intake (Yu Jun). From diagnosis, the Alzheimer’s Association estimates that the patient will live only four to eight years.

Although the rapid progression of Alzheimer’s is largely unexplained, recent developments in brain imaging technology have given researchers a greater understanding. Michael Thaut, Ph.D. and Gerald McIntosh, M.D. of the Dana Foundation have conducted studies with these new imaging techniques, and have found that music has considerable rehabilitative capabilities. Their studies analyze the interconnectedness of the brain by stimulating subjects with music, ultimately concluding that music enhances cognitive ability for Alzheimer’s patients. These results suggest that music can help individuals be more functional in their daily lives. For example, singing relies on the right hemisphere of the brain, while speech relies mostly on the left hemisphere. A person who is unable to speak is not, however, unable to sing, as we found with Phyllis. Another observation by Thaut and Gerald pertains to Parkinson’s disease. The rhythmic beat of music was an auditory cue, facilitating walking for patients who were previously unable. These auditory cues foster our natural cognitive functioning. While the brain’s response is still being researched, the human response suggests that music therapy can enhance function as well as improve quality of life.

Music therapy may be a key non-pharmaceutical method to lessening the detriments of Alzheimer’s. Numerous studies have found this to be true, comparing a control group of patients to one receiving music therapy. A randomized, controlled study conducted by Guétin et al. in 2009 found that music therapy could significantly decrease anxiety and depression for Alzheimer’s patients. Guétin et al. propose that the integration of music therapy could have valuable benefits for patients. Their results are backed by Svansdottir and Snaedal, who found that over six weeks, patients receiving music therapy had reduced anxiety and aggressiveness. Another study, from 2006, concluded that music therapy could subdue behavioral and psychological symptoms in a group of 59 dementia patients (Raglio et al.). These are among the few reputable studies that investigate music therapy and Alzheimer’s, but each yields promising results.

The challenges in conducting effective studies is one reason behind the underrepresentation of music therapy in elder care, mainly because it is difficult to measure responses from Alzheimer’s patients. The disease has varying severity depending on its stage of development, thus limiting a great number of patients from responding physically. Severely impaired patients may not visibly react to music, limiting researchers’ observations. Studies based on physical reaction do not capture what patients feel internally. Similarly, it is uncertain how music therapy affects other dementias, because most reputable studies consider only Alzheimer’s dementia, further limiting scientific conclusions. Additionally, researchers are unsure which methods best assess patients. How our brains store music in relation to memory is vague. Bucknell University professor Andrea R. Halpern questions whether musical memories are independent of context or more specific. Do we remember the melody of “Yesterday,” or the particular rendition of “Yesterday” by the Beatles? Researchers’ lack of an answer presents methodical challenges to music therapy studies.

In the medical world, music therapy is a small field, and while there are a few reputable studies on the subject, the depth and breadth of research lags behind research on pharmaceutical treatments. Successful drug design requires money, testing, and a strong company reputation. Music therapy has less access to these resources and lacks this same acknowledgement. Slim finances have limited the research conducted as well. Without the money nor the research needed to gain traction in medical communities, music therapy programs are underrepresented in America’s retirement homes. There are only 5,000 board-certified music therapists, compared to 1.4 million Americans living residential care communities (“Nursing Home…”). The lack of reimbursement for treatment also acts as a limiting factor. What if music therapy received the same funding as a major pharmaceutical company? Andrew Littlefield, blog writer and certified music therapist, estimates that a budget of $1.3 billion–comparable to many pharmaceutical companies–could fund up to 15,000 studies for music therapy. Littlefield’s calculations may be exaggerated, but his calculations affirm that “research is expensive, but necessary” in healthcare. Opportunities for Alzheimer’s research are growing, but current research remains insignificant compared to studies conducted by wealthier, recognizable companies.

What qualifies as standard music therapy is a disputed topic, which has further confused public perception. Two major organizations seek control of the therapy. The American Music Therapy Association, or AMTA, is the governing body behind the majority of U.S. music therapy programs, and has strictly defined music therapy. AMTA’s board-certified therapists deliver credentialed, professional music therapy with individualized goals. Often performed in groups, AMTA specifies that its therapy “differs from other bedside music.” But how so? The distinction between music therapy and music that is therapeutic remains undefined. Is music therapy only effective if it is practiced by a certified therapist?

Michael Rossato-Bennett’s documentary Alive Inside argues otherwise, and has sparked new national interest in music therapy. The film follows Music and Memory, an organization using iPod therapy in sixty North American facilities with a platform for future expansion. Unlike AMTA’s lengthy certification process, Music and Memory places control of the iPod program into the hands of the facility, providing iPods, headphones, and music. Facility staff then administer iPods sessions with personalized music for patients. The Music and Memory iPod program receives high satisfaction; for example, a reported 71% of facilities felt the program lowered their residents’ anxiety, 74% felt that the program aided staff in providing adequate care, and 94% would recommend the program to other care facilities (“FAQs” Music and Memory). The iPod therapy method may receive high approval ratings, but faces a major obstacle: nursing home staff are overworked, underpaid, and unlikely to provide quality therapy as a certified therapist. Because of this, the American Music Therapy Association believes that Music and Memory presents a “misleading and inaccurate” portrayal of music therapy that does not qualify as “clinical music therapy.” For an organization whose mission statement champions the expansion of music therapy, AMTA’s actions toward Music and Memory suggest the opposite. The organization’s unwillingness to compromise has stunted the growth of music therapy programs.

Could these two forms of therapy coexist? If AMTA were to partner with Music and Memory, the future of music therapy could have outstanding potential. iPod therapy could be used when certified music therapists are elsewhere. A strong volunteer workforce could provide iPod therapy, giving residents the personal attention and care they need. At present, however, the two programs are divided, even though there are far fewer AMTA-certified music therapists in America than there are iPods and volunteers. If the accessibility of iPods were combined with the expertise of certified therapists, music therapy would have the opportunity to expand immensely.

The skepticism surrounding music therapy still needs to be addressed. Steve Swayne, a Dartmouth professor of neuroscience, cautions the public in his article for The Atlantic. Swayne warns that music can overwhelm patients, producing an invisible and potentially harmful reaction in patients with limited physical responses. Even for non-communicative patients, neither staff nor professionals can tell whether they are joyful or anxious while listening. Swayne then proclaims that music therapy is not a cure to Alzheimer’s, even if it can appear to do so momentarily–a claim which is crucial to the understanding of music therapy.

The purpose of music therapy is not to cure the incurable. Its focus lies in improving quality of life, bringing joy, increasing functionality. Music therapist Grace Watts reflects on her work: “I can do something drugs can’t do, which is help [the disabled] communicate and, in turn, support their quality of life, relationships with their families and their experience and understanding of the world around them.” Our experiences with Phyllis capture just that. It was not long after we finished singing with her that she returned to her previous isolated state, but during the time we were with her, we alleviated her anxiety, fostered joyful interactions, and drew her out of the fog of Alzheimer’s. Through music, we formed a genuine connection with Phyllis, a resident who was among the least likely to form such a connection. Together, we helped her overcome her Alzheimer’s, without a single pill.

Phyllis is one of the 5 million Americans living with Alzheimer’s and 1.4 million U.S. nursing home residents. She is a woman who led a vibrant life, which is not visible by her mute wheelchair confinement. Music can revive that life and brighten her day. It allows her to communicate to us, even though her disease typically prevents her from doing so. It reconnects her with her identity. As we exit the Rehabilitation Center that autumn afternoon, bidding farewell to the usual folks in the lobby, we made Phyllis’s life a little better in those short few musical moments. As she approaches the end of her life, we know that we are bringing her joy and reawakening memories, one song at a time.

The author, Jason Albaum, checks that the volume of Phyllis’s music isn’t too loud or too quiet. Phyllis’s playlist contains the upbeat marches of John Phillips Souza, Big Band classics like “In The Mood,” and, of course, “Take Me Out to the Ballgame.”

 

Works Cited

 

“Alzheimer’s Disease Fact Sheet” National Institute on Aging, U.S. Department of Health and

Human Services, 16 May 2017, www.nia.nih.gov/health/alzheimers-disease-fact-sheet.

 

“FAQs.” Music and Memory, musicandmemory.org/press-room/music-and-memory-faqs/.

 

Guétin, S., et al. “Effect of Music Therapy on Anxiety and Depression in Patients with

Alzheimer’s Type Dementia: Randomised, Controlled Study.” Dementia and Geriatric Cognitive Disorders, 2009. Karger, www.karger.com/Article/Abstract/229024#.

 

“How AMTA and Music Therapy Relate to the Documentary Film ‘Alive Inside’ and the

Organization ‘Music and Memory.’” American Music Therapy Association, 3 Sept. 2014, www.musictherapy.org/music_therapy_and_the_film_alive_inside/.

 

Littlefield, Andrew. “What If Music Therapy Had Big Pharma Money?” The George Center for

Music Therapy, 5 Apr. 2013, www.thegeorgecenter.com/2013/04/05/what-if-music-therapy-had-big-pharma-money/.

 

Müllensiefen, Daniel, and Andrea R. Halpern. “The Role of Features and Context in Recognition

of Novel Melodies.” Music Perception: An Interdisciplinary Journal, vol. 31, no. 5, 2014, pp. 418–435. JSTOR, www.jstor.org/stable/10.1525/mp.2014.31.5.418.

 

“Nursing Home Care.” National Center for Health Statistics, Centers for Disease Control and

Prevention, 3 May 2017, www.cdc.gov/nchs/fastats/nursing-home-care.htm.

 

Raglio, A., et al. “Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric

Symptoms of Dementia.” Alzheimer’s Disease & Associated Disorders, vol. 22, no. 2, 2008, pp. 158–162. Lippincott Williams & Wilkins, Inc., journals.lww.com/alzheimerjournal/Abstract/2008/04000/Efficacy_of_Music_Therapy_in_the_Treatment_of.11.aspx.

 

Rossato-Bennett, Michael, director. Alive Inside. Amazon Video, The Film Sales Company, 2014,

www.amazon.com/dp/B01M0V0YB4.

 

“Stages of Alzheimer’s & Symptoms.” Alzheimer’s Association,

www.alz.org/alzheimers_disease_stages_of_alzheimers.asp.

 

Svansdottir, H. B., and J. Snaedal. “Music Therapy in Moderate and Severe Dementia of

Alzheimer’s Type: A Case-Controlled Study.” International Psychogeriatrics, vol. 18, no. 4, Dec. 2006, pp. 613–621. Cambridge University Press, www.cambridge.org/core/journals/international-psychogeriatrics/article/music-therapy-in-moderate-and-severe-dementia-of-alzheimers-type-a-casecontrol-study/D51CCDFF17656F27C927D1BA322BA74C#.

 

Swayne, Steve. “The Dangers of Overestimating Music Therapy.” The Atlantic, Atlantic Media

Company, 15 July 2014, www.theatlantic.com/health/archive/2014/07/the-dangers-of-overestimating-music-therapy/374402/.

 

Thaut, Michael, and Gerald McIntosh. “How Music Helps to Heal the Injured Brain.” Cerebrum,

The Dana Foundation, 24 Mar. 2010, dana.org/Cerebrum/2010/How_Music_Helps_to_Heal_the_Injured_Brain__Therapeutic_Use_Crescendos_Thanks_to_Advances_in_Brain_Science/.

 

Watts, Grace. “As a Music Therapist I Can Do Something No Drugs Can Do.” The Guardian,

Guardian News and Media, 13 Apr. 2017, www.theguardian.com/healthcare-network/2017/apr/13/music-therapist-adults-dementia-power.

 

Yu Jun, Ivan Seah. What Is Alzheimer’s Disease? TED-Ed, TED Conferences, LLC, 3 Apr. 2014,

ed.ted.com/lessons/what-is-alzheimer-s-disease-ivan-seah-yu-jun.

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How Music Can Help an Incurable Disease