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When nothing else works, a Queens University program proves that sound might be the most effective medicine

imageQueens' music therapy student Rose O'Toole plays the flute for Lawanda Saunders. Photo Credit: Charlotte magazine photographer Logan Cyrus
01/17/14 -  

Queens' Music Therapy Program is the backdrop of a Charlotte magazine (Feb. issue) story about the healing power of music therapy. A huge thank you to everyone at the magazine who made this wonderful coverage of the program possible!

Read this story on Charlotte magazine's website.

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Prescription: Music

When nothing else works, a Queens University program proves that sound might be the most effective medicine

 By Brandon Sneed

A young woman wearing blue plastic gloves and carrying a silver flute walks into the hospital room of a semi-comatose middle-aged woman. "Hi," the young woman says. "It's Rose. I'm here to play my flute for you again if you'd like. Does that sound good?"

The semiconscious woman-we'll call her Diane-doesn't open her eyes, but she does nod.

The soft notes slice through the irritating beeping and humming of hospital machines and ringing of telephones in the hallway. A sense of calm settles in, not just in Diane's room but all around it. People passing by slow down. Some even stop to listen for a moment. One doctor goes out of her way to thank Rose. "This is beautiful," the doctor says. "Just beautiful."

Diane isn't the only patient Rose O'Toole has visited today at Carolinas Specialty Hospital. O'Toole played guitar and sang for two others-a semi-comatose man who woke up enough to try to sing along and flirt with her and another man who loved him some country tunes. She carries with her a guitar and a large, blue bag full of instruments, including two small drums, rhythm sticks, shakers, and a tambourine.

O'Toole improvises as she plays, but what she chooses to play is not random. She uses her training in human physiology-not unlike what nurses learn-to choose music that helps Diane. Hospitals are tough places to sleep, and a person in a semi-coma isn't necessarily sleeping. To recover, Diane's body and mind both need rest.

As O'Toole plays, Diane's heart rate drops from the 80s to around 70, and she breathes slower and deeper, indicating she's likely fallen asleep.

Best anthropologists can tell, humans have been making music for at least 30,000 years. Plato wrote about music giving the universe a soul and everything life. We use it today as a soundtrack for anything we want, and its power and influence in our culture go without saying. But O'Toole isn't here just to entertain or provide nice background noise. She is a student being supervised by clinical coordinator Meg Johnson from Queens University's music therapy program.

Music therapy doesn't always work, and sometimes things can even go wrong, as O'Toole will experience in a moment with Diane. But it works often enough to take seriously, and that's why O'Toole is here. She believes what many others have come to believe-music can heal us.

***

Music provides incredible psychological therapy. It helps us process and cope with emotions, and sometimes creating music can become the therapy itself, as banging on a drum or playing something beautiful on a piano can express things we feel. When therapy helps us work through negative feelings, and we become happier, our body becomes better at healing itself.

But music therapy goes beyond one's emotions-it's designed to help the body and whatever ails it.

Imagine hiking in the mountains. You know the trail well because you've hiked it for years. But then one day, on your way back home, something happens-the trail washes out, or collapses, or flat-out explodes. Suddenly, a trail you've known all your life is gone forever and you have no idea how to get home.

It's not a perfect metaphor, but that's close to what happens in your brain after a major stroke or a traumatic brain injury.

Walking requires the activation of multiple areas of the brain, which signal to each other and send those signals through your body to your legs. This is a complex process that involves neurons firing throughout the brain. Same goes for eating, speaking, everything. These things only feel simple to most of us because our brains send commands faster than a light switch turns on a light, and we've been doing them all our lives.

When the brain gets injured-by stroke, for instance-and part of it dies, the neurological trail home washes out. The neurons can no longer find their way, so they can't make the body do what the mind wants.

During the past couple of decades, the idea of using music to enhance rehab has risen in earnest.

Music therapists believe music helps build new trails around the mountain. 

"Music activates across both sides of the brain, and front and back, simultaneously," says Dr. Becky Engen, director of the Queens University music therapy program. "When there's an area of disconnect-say, a stroke killed part of your brain-because of that activation all over the place, we're able to still access and connect things through music that maybe couldn't be connected otherwise."

What they do goes beyond making music to motivate someone through a difficult rehabilitation session. Music therapists work with individual patients to provide them with their own personal rehab soundtrack, live and in person.

"But they're not just providing background music," Engen says. "That's a piece of it, but it's more. We can change the key, tempo, instrumentation, accents-we can manipulate the music to do what we need it to do. That's the beauty of this: We can shape the music. It doesn't respond to or accompany the movement. It leads the movement."

And that music creates rhythms patients' brains learn to follow as they learn or relearn things they either don't know or forgot how to do.

In late November, two Queens students and Dr. Varvara Pasiali visit Phillips Academy, a special-needs school off Providence Road. The Queens students are here to work with eight children and young adults, ages 15 to 21. The kids gather in a circle, wearing pj's because today's Pajama Day.

"Think, listen, look, and then act," the instructors tell them, handing out wooden rhythm sticks of various colors-red, green, yellow, blue-for the students to strike together in a beat.

Music therapy doesn't just work for someone who's been injured. It works for people suffering from degenerative diseases, genetic disorders, and mental illness; even premature babies can benefit.

In the case of Alzheimer's, for instance, music can connect various parts of the brain across damaged areas in ways that trigger lost memories. With Parkinson's, music can help patients' brains remind their muscles how to operate more efficiently, thus reducing those notorious shakes.

"You can improve cadence, stride length, velocity," says Pasiali, an assistant professor in the Queens music therapy program. "Basically, music creates rhythms that restructure the brain to function more efficiently."

For people with autism, music therapy can help them develop better cognitive skills by playing games that involve responding to various musical cues.

After rhythm sticks, the instructors ask the Phillips students to recall lyrics to various songs. Then they play the students' favorite game. They gather around a parachute, and each takes a handle. They raise and lower their section based on musical cues provided by one of the teachers playing a guitar and singing "Lean on Me." At the end of the session, they flap the parachute as fast as they can. It sounds like a happy, beating heart.

Not only do the Phillips students have a blast, the drills also help their brains learn to focus on proper coordination, which is often a struggle.

People with autism spectrum disorder sometimes have constant cognitive overload. And they struggle to distinguish between the things they need to ignore and the things they need to process.

But music can help train an autistic mind to ignore distractions. "It can help children refocus and teach them attention skills," Pasiali says. "It helps you allocate your brain resources."

At Queens' on-campus music therapy clinic, therapists work with autistic children on the piano by assigning numbers to their fingers and using those numbers to signal which key to strike. The purpose isn't to teach them to play the piano, or even to hit the right keys: It's to train their brains and boost their motor coordination as they work to use the right fingers at the right time. Creating music fires up more areas of the brain than they would experience in verbal instruction.

In the case of babies born prematurely, music therapy has led to reduced hospital stays by enhancing weight gain, brain development, and oxygen saturation.

***

There's a difference, Engen says, between trained music therapists and people who volunteer to play live music for hospital patients. Not that there's anything wrong with those volunteers, Engen is quick to point out. "We hope they keep doing that," she says. "It can be a lovely distraction."

Where music therapists go beyond that is in their knowledge of how to use music to work with your brain to help it heal you. "They can address emotional issues, or social, cognitive, psychological-all domains," Engen says. "Everything about your brain can be addressed through music."

New developments in technology and neuroscience have enabled music therapists to establish evidence that music has profound effects on the body because of the profound effects it has on the brain. Using EMG tests, for instance, researchers have found that neurons fire in more symmetrical patterns when music is playing.

The brain is a stunningly plastic organ. When it loses functioning in one area, it has some capacity to re-route its directives, enabling other parts to take over for the damaged areas.

Music therapy helps the brain find ways to piece itself together around the broken areas. And for people born with a genetic disorder, such as autism, it can help their brains find a new neural pathway.

So, why not just give them an iPod?

Pasiali says the major difference lies in how music therapists have a deeper knowledge of human physiology and behavior, which they draw on to interact with patients in the most effective ways. "That is quite different from a CD," she says. "Or even someone who's a volunteer musician just going to play the piano or guitar for an hour."

Think about what it means to listen to music. You're not just hearing noise. You're gathering information. Whether listening to, creating, or performing music, we're ordering abstract sounds into highly complex, temporally ordered sound patterns. We perceive music in multiple dimensions, our brains tracking simultaneous pitches across time and space to decipher the melody, or polyphony. And then our brain processes all of this into rhythmic time patterns. That's kind of a workout.

Neuroscience, brain scans, and other studies are starting to show this has a very real influence across the brain in ways other therapy never has. "Neuroscience is confirming a lot of what's been seen by observing behaviors," Pasiali says, "so it's beginning to validate 50, 60 years of psychological research. And finally getting some of that validation from the medical and scientific communities-it's nice, but I think it's also important."

Before there was scientific evidence, though, what caused people such as Engen and Pasiali to believe in music therapy enough to pursue it as a career? How did they have that kind of faith in its healing power?

It's pretty simple: They watched music change people.

Nearly 20 years ago, Engen was working as a music therapist at an in-patient psychiatric facility in Des Moines, Iowa, when she was presented with the case of a badly broken young lady named Joy. A low-functioning adult with a developmental disability, Joy also suffered from schizophrenia. What's more, Joy had been lobotomized. "So she had difficulty with her emotional regulation, too," Engen says.

Joy had been institutionalized her entire life. Countless attempts at halfway houses had failed. "If you harm someone, you get kicked out," Engen says. "And she'd always have these outbursts."

The outbursts were most often caused by her poor eyesight and the fact she was easily startled. Those factors, combined with her emotional instability and schizophrenia, created a volatile reaction in which Joy became the opposite of her name. Forgetting who and where she was, Joy would attack whoever was near her, no matter who it was. She gouged, stabbed, bit, threw things. She didn't just harm people; she sent them to the hospital.

"In a three-state area, she'd burned all of her bridges," Engen says. "They said she had to be successful in a group home, but they just didn't know what to do with her."

But Engen had an idea. She chose a song, "You Are My Sunshine," and she had the staff at Joy's institution learn it, and whenever Joy would become startled and begin one of her outbursts, Engen or a staff member would sing to her: "Joy is my sunshine, my only sunshine ..."

Now, Engen says, Joy has lived in the same group home for 15 years and hasn't put anybody in the hospital. When she forgets everything else, she remembers the music, and the music always brings her back.

Of course, sometimes it doesn't work, and sometimes things do go wrong, but then that's why a CD just can't compare to care from a human being.

***

As O'Toole plays for Diane, her flute-induced trance breaks when Diane begins choking horribly. Diane's heart rate shoots up, and a respiratory therapist comes in and struggles to adjust the breathing tube. Diane's heart rate keeps rising, and she's not breathing. Beeps are becoming alarms.

O'Toole stops playing, lowering the flute to her side, but she doesn't panic. She doesn't flinch. She starts to sing the Anna Nalick song, "Breathe (2AM)," her voice weaving through the chaos in Diane's room and mind: "And breathe, just breathe. Ohhh, breathe. Just breeeathe." 

And she does. 

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