As the audience applauded in Steinmetz Hall at the Dr. Phillips Center for Performing Arts in Orlando, Florida, little did they know that five of the percussion groups on stage were stroke survivors. However, they didn’t drop a beat on their cabasas, drums and djembe. What the audience also didn’t know was that the performance was part of a music therapy session, music has been shown to activate various centers of the brain.
As one participant put it, “my emotional well-being is through the roof because of it.” And he was comforted by the fact that there were others like him in the group, energized by the association as fellow survivors of what could potentially have killed them.
The five stroke survivors and their families were working with musicians from London’s Royal Philharmonic Orchestra (RPO), which in partnership with Hull and East Riding Community Stroke Services, part of a UK NGO called City HealthCare Partnership, has specially adapted musical techniques to address the complex needs of stroke survivors and their caregivers.
The Royal Philharmonic Orchestra’s special programme, called Strokestra, began with an intensive research and development phase and was trialled as a five-month program in 2015. Researchers found significant improvements in patients, carers and staff after to learn piano, drums and violin. and interact with musicians.
Program implementers claimed that 86% of patients experienced relief from disabling symptoms and actually had improved sleep, reduced anxiety, less dizziness, and reduced epilepsy symptoms. Ninety-one percent reported social benefits, such as improved relationships and communication skills, 86 percent found cognitive benefits, such as increased concentration, attention and memory, 86 percent improved emotionally, citing increased confidence, morale and sense of self, while 71 percent. improved physically, including walking, standing, arm strength and endurance. But what stood out from the data sheet was that 100% of caregivers reported an improved relationship with their patients. Although researchers still don’t fully understand how it happens, MRI studies have shown that music therapy improves brain plasticity. Brain plasticity refers to changes in the structure of the brain.
According to Dr. Amit Jain, Consultant Pain and Palliative Medicine, Dharamshila Rahat Supportive and Palliative Care Center, says music therapy is a simple, safe and easy rehabilitation routine for stroke survivors. It promotes the recovery of cognitive functions, helps to improve dysphagia, facilitates the training of the motor exercise of the limbs and promotes the recovery of speech.
Since aphasia is a common consequence of stroke among Indians as well, music therapy can be quite effective as a treatment protocol. There have been examples where individuals, who struggle with their speech, are often able to sing, says Dr Jain. “After a stroke, one part of the brain is affected and eventually the functions that were controlled or regulated by that part slow down or stop. When you listen to music, its beat and rhythms try to train or rewire the brain in what is called neuroplasticity. Music therapy helps restore these functions to some extent,” explains Dr. Jain.
He adds that any chronic stroke patient with difficulty with upper limb function or limb coordination should take piano lessons. It is unknown whether all individuals with stroke will respond similarly to these classes or gain through them, but they can still be tested for better functional levels of motor recovery.
“Music releases endorphins that give you a sense of excitement, calm your anxieties and stabilize your pain and your immune system, all while controlling depression. Music connects with the autonomic nervous system, which stabilizes blood pressure and heartbeat,” adds Dr. Amit.
Meanwhile, Dr. Praveen Gupta, director of Neurology at Fortis Memorial Research Institute, says it is still questionable whether music therapy will lead to structural architecture and changes in the brain, which are part of brain plasticity. He argues how these studies are largely about physical well-being, the increased socialization and general sense of well-being that any socio-cultural activity, including music, will provide. “The music-based studies conducted under the program are actually dealing with the felt outcomes of the patient rather than the objective outcomes of stroke improvement, which can be assessed on cognitive or physical tests. There is a lot of subjectivity and bias and it would be better that further studies on the impact of music on stroke recovery be based on more objective criteria. Theoretically, any learning task will stimulate brain function and lead to brain plasticity,” says Dr Gupta. “Doing any coordinated physical activity will lead to functional benefits of the brain, regardless of whether it is injured or healthy. I reiterate that brain plasticity, which refers to change in brain functioning, is best assessed by functional brain imaging rather than just a simple MRI,” he adds.
Dr. Gupta says that if an injured brain is taught language, writing, or music, it will cause a change in the brain’s circuits, resulting in neural plasticity. However, a PET scan will be much better at assessing brain plasticity than an MRI because the former is capable of functional neuroimaging while most MRIs are capable of structural neuroimaging.
“It should be noted that the field of music and speech are not the same. This is why people who stutter can sing perfectly. The study clearly emphasizes that a letter-based therapy versus an instrumental therapy had better effects and resulted in stimulation of the integrated sensorimotor pathway for language, which is possible,” he adds.