Why music is winning a wider audience in medicine.
Ursula Sautter | March 2010 issue
Photo: istockphoto.com/photogal
Music has always been an integral part of Erich Paul Richter’s life, both before and after the night in early 2007 when he had a stroke that deprived him of control of the left side of his body. The classical works he used to perform as an organist and harpsichordist with the Messias Church of Hannover, Germany, were intricate and beautiful; the tunes the 50-year-old plays on the keyboard these days are simple and not all that pleasing to the ear. Yet for Richter, the monotonous note sequences he has been practicing since soon after rehab are crucial. With their help, he has been steadily regaining the ability to use his once-useless left hand. “This, and being able to produce a melody again, is a great reward,” he says.
These music-supported training (MUT) exercises, developed by Eckhart Altenmüller and his team at the Institute of Music Physiology and Musicians’ Medicine (IMMM), also in Hannover, have proven a much more effective treatment when combined with traditional rehabilitation methods such as physiotherapy. Studies have shown that MUT’s combination of auditory and sensorimotor stimulation led to more pronounced improvements “with respect to speed, precision and -smoothness” of finger movements than ordinary therapy, according to a study in the Journal of Neurology. Moreover, motor control in everyday activities—grasping an object, zipping a zipper—also improved.
For decades, psychotherapists have used music to treat people with psychological and behavioral problems. More recently, though, music-based therapy of the kind experienced by Richter has become a popular complement to surgery and drugs. In the U.S., doctors use music to help stroke victims relearn to talk. In Canada, it’s employed to make surgical procedures involving spinal anesthesia more bearable. German physicians use it to ease migraines. In Israel, it has been shown to improve cognitive function in schizophrenics. And in Switzerland, music is used as a treatment for geriatric patients with -cognitive problems.
Whether it’s administered in an operating room, an assisted living facility or a therapeutic clinic, music has “the huge advantage of having no side effects,” says Stefan Koelsch, a neuroscientist at the University of Sussex in Brighton, England. And “unlike a drug, it will also continue working after its immediate effect has phased out.”
Music and medicine share a long history. The oldest evidence of musical therapy goes as far back as the third millennium BCE, when Sumerians composed temple hymns to cure the sick. Healing incantations and musical instruments were also prescribed in ancient China and Egypt. In The Odyssey, Homer describes how a healer’s chant stopped a wound from bleeding. Music remained part of the curriculum for aspiring physicians until the 17th century, when it was employed to treat disorders. It was only in the 19th century that music lost its link to medicine.
But music’s physiological effects are as pronounced as its psychological effects. For more than 20 years, Ralph Spintge, an anesthetist at the Hellersen Sports Hospital in Lüdenscheid, Germany, and president of the International Society for Music in Medicine, has used music as an analgesic and sedative during operations and examinations. His patients, he says, require “fewer painkillers and stress-reducing medication.” Aside from drawing the patient’s attention away from other sensory stimuli (the whirring of a bone saw during a hip replacement, for instance), he says music “directly dampens” the brain regions responsible for processing pain. Experts think music boosts the activity of pain-blocking nerve pathways, too. Physiologically, it “normalizes the heart rate, arterial blood pressure and breathing, and lowers levels of stress, pain hormones and muscular tension,” Spintge adds. Electroencephalography (EEG) measurements have shown that music can induce quasi-sleep states, which can be helpful before surgery. Some effects continue for up to an hour after the music has been switched off.
At Spintge’s hospital, patients can choose from 10 music genres. Patients either take headphones with them wherever they go—from the hospital room to the prep room to the operating theater—or listen to music played via speakers. This allows people to exert some control in “a situation they otherwise have no control over,” Spintge explains. “That’s very important psychologically.” While some people rely on the soothing New Age crooning of Enya or the harmonies of classical music for calm and comfort, he says, others—especially youngsters—prefer the pounding of heavy metal (Metallica is always a hit) or the songs of the Beatles, Queen or the Rolling Stones. While the choice of genre is individual, all the pieces share one feature: They have high -recognition value and pronounced rhythms that soothe the central nervous system.
When using music in physical therapy or as a treatment for chronic pain, patients may be asked to listen to canned or live music, play tunes on an instrument (anything from drums to the piano to the xylophone) or even compose pieces themselves. The music may be administered in short or long sessions every day for many months. It may be more effective when it’s a favorite or when the listener has never heard it before. And it can be used for adults, teenagers or young children.
Take the use of music for psychological disorders. Using functional magnetic resonance imaging (fMRI) scans, the University of Sussex’s Koelsch has shown the effect of pleasant instrumental tunes known to the listener on the hippocampus, part of the limbic system that regulates emotions. In people suffering from depression or post-traumatic stress disorder, for example, the hippocampus is “partly switched off,” Koelsch says, and even loses some of its neural tissue. The result is a dearth of positive feelings and joyfulness. An energizing boost of “happy music” seems to turn the hippocampus back on.
In one of Koelsch’s current studies, -patients suffering from depression responded with mood upswings to musical exercises in which they played the drums and other percussion instruments. “After we let them play for 45 minutes or an hour, even those who entered the room in a deep blue funk leave with much brighter faces and a spring in their steps,” says Koelsch. “So you could say that the great power of music is to evoke hippocampal activity related to -happiness.”
The influence of music—whether we listen to it or play it—reaches further than the limbic system. Petr Janata, associate psychology professor at the University of California, Davis, studied people as they listened to songs that were hits when they were kids. Janata found that familiar songs that elicited pleasing recollections from the past activated neurons in the medial prefrontal cortex (MPFC), the brain region responsible for storing and retrieving memories. The findings could help explain why music still gets through to late-stage Alzheimer’s patients when very little else does. “The MPFC is the place where we link memories, music and emotion,” Janata says. “It is also one of the last areas of the brain to be destroyed by the disease.” He suggests that specially structured, customized playlists that evoke strong positive memories could help improve the condition of Alzheimer’s sufferers.
Music has also proved effective against aphasia, the loss of the ability to speak fluently, usually in the aftermath of a stroke or head injury. The language area of the brain, what’s called “Broca’s region,” is often damaged in head injury and stroke patients, rendering them unable to articulate words and sentences properly despite understanding what others say and knowing what they want to answer. Exploiting the fact that song lyrics are processed in a different area of the brain, Gottfried Schlaug of the Beth Israel Deaconess Medical Center in Boston is successfully training aphasia patients to relearn speech by chanting. Using what he calls “medical -intonation therapy,” Schlaug and others coach patients to sing phrases along with the therapist and then—as the unharmed brain region becomes more adept at taking over the linguistic functions of the original language center—eventually say them. Even stroke sufferers who hadn’t responded to traditional therapies can thus regain the ability to talk.
Vera Brandes, director of the Music-Medicine research program at the Paracelsus Medical University in Salzburg, Austria, wants to take music therapy to the next level. She prescribes individually composed music for various ailments, just as medicines are created for specific illnesses. Working with scientists from Germany and the U.S., Brandes, a music producer in a previous career, invited 32 hypertension sufferers to listen to some specially composed tunes once a day for four weeks. At the end of the trial period, she found that the heart rate variability (HRV) of the participants increased; an active HRV is considered an indicator of the body’s autonomic regulation of circulatory functions. Other Brandes studies, involving burned-out and depressed individuals, produced similar results. Why music has this effect is what she is trying to find out through further research. If they are used at the right moment of the daily biorhythm, Brandes says, “these custom-made acoustic drugs cause a beneficial neurological effect in the listener.”
Music therapy isn’t a replacement for traditional medicine, agree all researchers in the field, but it can shorten recovery times, reduce pain and alleviate the psychological stress caused by disease, with little expense and no side effects. When music is used, though, it should be part of a treatment regimen supervised by a psychotherapist or doctor. “The first step is always to see a physician,” Brandes says. For Erich Paul Richter, the dream of playing the harpsichord or organ with his old aplomb may remain just that—a dream. But with the help of the keyboard, he’s at least learning to master his own body once more.
Ursula Sautter never goes anywhere without her iPod.
