Sunday, December 9, 2012

Kinetic Melody: Parkinson's Disease and Music Therapy (Chapter 20 of Oliver Sacks' Musicophilia)


Oliver Sacks Musicophilia (2007)

Chapter 20: Kinetic Melody: Parkinson's Disease and Music Therapy


In this chapter, Sacks looks at music therapy for Parkinson's disease and other neurological disorders, such as Huntington's disease and encephalitis lethargic. The latter is a disorder that occurred as the worldwide epidemic of sleeping sickness after World War I, with patients in a frozen-like state for forty or more years. Some patients could not speak, and when they could they lacked tone and force. As in Parkinson's disease, these patients had trouble initiating movements - but amazingly they could often respond to movements if, for example, a ball were thrown to them. Also, patients could sometimes move with great naturalness, often when hearing music. The patients that could not speak could sometimes sing.

Music therapy began informally after the second World War with large numbers of soldiers returning with PTSD. Musicians would informally play in hospital wards and see tangible improvements in patients. In 1944 the first music therapy program was started (at the University of Michigan).

Parkinsonism affects not just movement, causing a kind of 'kinetic stutter,' but also, when more severe, affects thoughts, feelings and flow of perception (p. 274). However, Parkinson's patients can, with the right music, experience ease of movement. Generally the music used has to have a legato melody, with a steady, but not overpowering, pulse.

Some patients reported that even just imagining such music freed her from the wooden movements - though the mental music would sometimes stop and the symptoms would return. Similarly, patients report that walking with another person, falling into a rhythmic step, helps to initiate her own movement; again, when their partner stops, this patient would involuntarily stop as well. Another symptom of Parkinonism is 'personal time' - that the patient's perception of time is drastically slower than other people's perception of time, but that they will only be aware of it when compared with a clock or another person. Again, music can restore this sense of time.

Parkinsonism's main problem is the inability to spontaneously initiate movement, due to a damaged basal ganglia. If severely damaged, patients cannot initiate spontaneous movement, though are still able to respond to stimuli such as throwing a ball - for short-term movement - or music, for a slightly more prolonged period of movement.

Most strikingly, Sacks mentions a patient who could walk only with wooden movements and whose hands were generally immobile. But due to the patient's previous musical training, she could still play the piano, with her hands expressive and her facial muscles would relax and gain expression. Simply saying the name of a Chopin piece to this patient would cause her body to relax - results that were mirrored by an EEG scan.

The best therapy, Sacks notes, is music combined with movement, such as dance, which can be helpful to patients with Huntington's disease as well. Dance, or any activity with a regular rhythm (sometimes even a sport) can be therapeutic for a brief period of time, and sometimes for a short time afterwards, alleviating symptoms.


A few years ago, I met an lady at the conservatory in her late seventies who had Parkinson's disease and whose hands always visibly shook. I would meet her on her way to an intensive Japanese Taiko drumming every week. I had tried the class once and left half-way through because I found it too straining and so I could not imagine this frail lady participating in such an activity. The lady explained to me in great detail how the Taiko drumming regulated her body's rhythm and how she felt this rhythm throughout her body. She said that during class she did not feel any inhibition of movement and also for a time afterwards (she cited the effect as lasting a few hours). It was not until I read about music therapy that I really believed the profound effect that she was describing was possible.

Oliver Sacks' chapter on Music therapy for Parkinsonism is a fantastic introduction to the topic filled with interesting cases of individuals that are affected positively through music and movement. As with other chapters in the book, I would wish for a more substantial section on the neurology behind such treatments, though it does make me want to read much more on the topic. An elderly relative of mine has Parkinson's and I know that they have not tried music or dance therapy - and so I intend to dance with them when I see them next.



Vivek Sharma said...
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Vivek Sharma said...

This is a fascinating topic because the compartmentalization of cognitive abilities seems particularly striking when areas of the brain that are responsible for the integration of cognition are damaged. Particularly interesting is the account of Parkinson's that is described here.

It is not surprising that music and its association to movement aid in motor initiation and automation. I actually did not know that behaviors like catching a ball could go unaffected by Parkinson's disease. I feel that music has the ability to shift the balance between competing inhibiting and exciting forces within the brain. During a static state, when excitation is required to break stasis, inhibitory forces maybe causing difficulty unless a stimulus excites an automated or reflexive behavior. For this reason, I agree that movement should be involved in music therapy. A multi-modal approach might help break the inhibitory forces I described above, possibly by channeling attention in ways that can break inhibited states.

The facts about the history of music therapy were also interesting. It makes sense that WW2 would impel the use of music in healing, since injuries of various kinds were widely available for observation. Music therapy as a treatment Parkinson's is so interesting, especially because of how it links music to motor processing.

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