Monday, November 12, 2012

Music Therapy, Alzheimer's and Post-Traumatic Stress

Music Therapy, Alzheimer's and Post-Traumatic Stress
Podcast from the Library of Congress Music and the Brain Series
Host: Steve Mencher
Guest: Alicia Clair (Prof. of Music Ed. and Music Therapy at the University of Kansas)

In this podcast, host Steve Mencher talks to Alicia Clair about how she uses music therapy with her Alzheimer's patients, as well as with veterans with post-traumatic stress disorder and traumatic brain injuries.

Mencher first brings up the fact that music therapy in the US received a "boost" in the 1940's when it was used as successful treatment for veterans coming home from WWII. He asks Clair about this and she goes on to discuss that music was used as a daily regimen of treatment for soldiers who had shell shock and other various disabilities due to the stress of war. At this time, they had full music programs, orchestras and choirs in which patients participated. Although therapists didn't know how music was impacting their patients on a neurological level, they did know that music therapy was helping to relieve stress and increase social engagement among the patients.

Mencher asks Clair what was going on in the brains of these veterans, in what we now know as post-traumatic stress disorder. He asks: what was happening to them and how was it helping? Clair answers that when people hear music, it automatically "dampens" their autonomic nervous system. In response, breathing may deepen and heart rates may slow down. There may even be a release of muscle tension. Music gives patients a "space" where they can be free of anxiety, where they can "let go".

Clair continues to discuss how when people have traumatic brain injuries, psychologists need to go back and do a lot of "remapping". They may do physical therapy where they use music to entrain rhythm and facilitate motor movement. They may also use music in what she calls "tension control training".

Mencher asks Clair what "executive function training" is. Clair responds that executive function has to do with higher-order decision making and judgement, which is very important to daily life. It also has to do with being able to control impulses. She mentions that although Veterans may recover on a physical level, they may not have full cognitive function that will allow them to go back to work or interact normally with family and friends.

Mencher asks how music helps with the "remapping" of the brain, and what "remapping" is in this context. Clair says that the brain is plastic, it has the potential to change. If there is an injury to one part of the brain that results in a loss of physical movement, the brain can re-wire itself to use a different area of the brain for that lost function. However, Clair says this takes a lot of work. She continues on to say that music probably has the greatest impact on the rehabilitation of motor movement (walking, speech etc), as it activates the motor centre of the brain and helps patients synchronize their movements.

Clair then discusses the music she uses with her patients. She says that quite often music therapists will compose or improvise music for specific purposes and with certain tempos in mind. She says the music used in therapy is often live, but that they also prescribe recorded music to patients to practice at home. Clair continues on to say that sometimes the most "successful" music used in therapy is the music patients listened to in their early adult years (about age 15 - 23). She says that hearing this music elicits associations which can be visual, olfactory, auditory or emotional. While Clair says that this music can be the most "successful" music for therapy, she also says that it can sometimes get in the way of therapy, depending on what the therapist is aiming to achieve (perhaps the associations and emotions that are conjured up hinder other cognitive rehabilitation).

Mencher continues on to ask Clair about her work with Alzheimer's patients in the late stages of the disease. She discusses how music can be a helpful way for her patients to engage socially. This can be done through dancing, movement, or singing in groups or with family members. Clair also discusses how music can be used to decrease stress in Alzheimer's patients, who often experience confusion or are easily disturbed by change in their environments. She mentions that if stress levels are low, patients more likely to adapt to change without difficulty. They are also more likely to engage in "procedural memory" (how to put on pants or a shirt). When stress is high, these habitual memories are suppressed. Since music helps dampen the autonomic nervous system, it reduces stress and increases quality of life for her patients.

Mencher concludes by asking Clair if she has anything else she would like to share with the audience. She responds by commenting that even if a caregiver or family member has no musical training, he/she should try to use music with the Alzheimer's patient. Clair mentions that singing instructions is actually more effective than giving them verbally. This is because the patient's brain processes melodic instructions easily than without the melodic component. Clair concludes that using music is the "most endearing and close connection" a caregiver can have with the patient.


I found this podcast to be very interesting and informative. I was amazed to hear that therapists have been using music in the rehabilitation of war veterans since the 1940s. I had no idea that music has been used in rehabilitation for so many years. I was also intrigued by the fact that music "dampens" our autonomic nervous systems, slowing our breathing and heart rate, and thereby reducing anxiety and stress. It's quite fascinating that even when our memory and cognition is weakened (as in Alzheimer's patients), music can effect us on such a deep, primal level.

Another interesting point about the effects of music on Alzheimer's patients, is how music helps reduce stress in patients and enable them to engage in "procedural" memory (putting on pants etc). This makes me wonder how stress impacts cognitive function in general. Does stress hinder our performance of cognitive tasks, learning or memory? This podcast suggests that this is the case. In this last (stressful) month of classes, perhaps we should all make sure to listen to some music before we study or write our papers!


agemattersclinic said...

Music therapy can help those with dementia and memory loss. A case study and the benefits of music therapy are presented in this article.

Alzheimer specialist

Suzanne said...

I was also surprised to learn how long music therapy has been in use. One would think that a form of therapy that has been in use for such a long period of time would be more mainstream.
Given what I've learned in this course about different types of music causing different levels of arousal, I am wondering if specific types of music are more effective for reducing stress and "dampening" the autonomic nervous system. I wonder if the types of music that help alzheimer's patients are generally useful or highly individualized.
The fact that music can help trigger procedural memory brought this question to mind: Would it be helpful to listen to music while learning new skills, then to play said music to trigger procedural memory of those skills? Just a thought . . .

G.M. said...

To answer your question Suzanne about the type of music that alzheimer's patients listen to...I recently watched the Alive inside documentary which followed the reaction of Alzheimer's patients to music listening. The music used in the documentary was usually from the time that patient was a young adult. (Actually David Huron has conducted research on the importance of that period to our musical preference.) However, during the panel discussion, someone asked if the music had to be individualized and the panel responded that any kind of music would. I am not sure if they're right though...

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