Wednesday, November 13, 2013

Mathematics and Music: A Search for Insight into Higher Brain Functions

Mathematics and Music: A Search for Insight into Higher Brain Functions

Authors: Wendy S. Boetcher, Sabrina S. Hahn, and Gordon L. Shaw
Source: Leonardo Music Journal, Vol. 4 (1994), pp. 53-58

“Until just before his sixth birthday, then, Wolferlled (Wolfgang) a happy and not too burdened life... He learned his lessons, whatever they were, easily and quickly. His mind was usurped by music until he discovered the rudiments of arithmetic. Suddenly the house erupted with figures scribbled on every bit of space walls,floors, tables and chairs. This passion for mathematics is plainly in close alliance with his great contrapuntal facility. Music, however, was his only real interest.

Throughout history, one of the most intriguing and common connections between science and the arts is the relationship of mathematics and music. This is no coincidence as physics and mathematics, explain acoustics, sound production and many other principles that are the foundations of music. Some composers such as: Gubaidulina, Bartók and Satie have even incorporated mathematical concepts into their compositions such as the Golden Ratio and Fibonacci sequence. Connections between mathematics and music are numerous but the aim of the article by Wendy S. Boettcher et al, is to examine these areas as processes of higher brain function.

Boettcher et al did not only base their research on previously raised points; they also presented results of interviews with 14 professors of mathematics concerning their research and relations to music. According to the authors, the cause of the higher brain functions that apply to mathematics and music is an abstract, spatio-temporal firing-pattern development by neurons grouped over large regions of the  cortex. In order to clarify development patterns in the brain besides music and mathematics, the authors analyzed chess-playing skill as a complex cognitive process equivalent to mathematics and music-related operations.

An insight into higher brain functions is discovered through accessing the Trion Model, which is according to the authors, a highly mathematical realization of the Mountcastle organizational principle. Vernon Mountcastle is an American neuroscientist who discovered, in the 1950s, columnar organization in the cerebral cortex. According to Mountcastle, cortical column is the basic neural network of the cerebral cortex and consists of subunit minicolumns called trions. Trions represent structured and intertwined bundles with the overall diameter of about 0.7 mm  containing about a hundred neurons. Each trion has three levels of firing activities and therefore, a cluster of trions can produce a complex and rapid firing pattern characteristic of higher brain function.

Music is comprised of melodic, harmonic, and rhythmic sequential patterns. Melodic patterns, or patterns of continuous notes, produce a frame that helps the listener recognize a familiar melody or make a distinction between two different melodies. Harmonic patterns relate to the  horizontal dimension of music, while rhythmic patterns involve the timing aspect of music. The authors discuss an experiment in which college students were exposed to the music of Wolfgang Amadeus Mozart before they were given intelligence quotient tests. The results of this experiment showed that the music of Mozart, which possesses natural complexity and structure, enhanced the abstract and spatial reasoning of the students. Even though music is highly organized by patterns, several studies have produced negligible results connecting computational and musical abilities in children.

The authors interviewed 14 mathematicians and posed the following questions: (1) “What is your math research?” (2) “What are some cognitive skills that are required to do this type of research?” (3) “Do you believe there is a connection between math and music?” (4) “Do you listen to music while doing math?” For the purpose of this text, probably the most important is the question number 3. Most of the mathematicians expressed their appreciation and knowledge of music but the majority said that the cognitive relationship between music and mathematics exists only at the level of detecting patterns.

As a musician and admirer of mathematics, studying this article has been of great importance and insight for me. Understanding the nature of sound and its fundamental relationship to physics and mathematics, being aware of the fact that some composers were successful in both areas, for some reason, never took my understanding in the direction of organizational patterns of music and math. In my opinion, the music of Mozart and other classical composers might be described as a sequence of predictable melodic, harmonic, and rhythmic patterns, but the exclusive implication of patterns can be found in the music of the contemporary composers. The music of the 20th and the 21st century, predominantly atonal or serial displays an even greater application of mathematic than tonal music. Focusing on the  proportions and relations of notes or sounds within bigger forms is one of the main characteristics of contemporary music. Graphic notation, symmetric structures, golden ratio and Fibonacci numbers are some of the fundamental techniques composers use today and even if no apparent pattern can be determined in writings of a composer, such an approach is a result of pattern-directed thinking. 

Tuesday, November 12, 2013

Music therapy for Dementia

Music therapy for dementia by SangNam Ahn and Sato Ashida


Dementia is defined as “loss in short – and long- term memory, associated with impairment in abstract thinking and judgement, other disturbances of higher cortical function, and in some cases, personality change” and is fifth leading cause of death among older people. Although there is pharmacotherapy treatment for some symptoms, there are many side effects to patients. “Music therapy has been employed and welcomed as a safe alternative approach because of its ability to alleviate some symptoms of dementia, and to elicit remarkable responses from patients.”

Since music is familiar and predictable, it has a remarkable ability to elicit memories, movements, motivations and positive emotions from older people who are suffering from dementia. Firstly, singing is one of the methods; patients who have lost verbal skills can sometimes continue to sing lyrics to familiar songs, allowing them to express feelings. “When ability to sing deteriorates, familiar songs or the entrainment technique have been used to facilitate meaningful interactions and elicit positive reactions leading to reduction in agitation, depression, and restlessness.” Furthermore, listening to music may decrease stress hormones like cortisol and help patients cope with exhaustive dementia symptoms and associated fears. Moreover, the author pointed out that music therapist should make patients participate as possible. “Allowing patients to play music or move rhythmically can help maintain or improve gross and fine motor coordination. Music and dancing skills learned over the years often occur automatically well into the later stage of dementia, allowing patients who have lost other social and cognitive skills to participate and gain a sense of success and competency.” Although there are good responds to music therapy, the research gaps exist that hinder our confidence to call music therapy an evidence-based medicine, or a clinical expertise integrated with the best available external clinical evidence from systematic research. “The first step in filling the research gap would be to conduct more randomized clinical trials to establish the efficacy of music therapy on dementia symptoms using more vigorous measures such as structural magnetic resonance imaging and behavioral and endocrinological assessments, using established measures to better quantify cognitive status.” The ultimate goal is to develop music therapy programs that are delivered by certified music therapists who employ strategies based on extensive evidence.


Since dementia is one of terrible diseases, this article was very interesting to me to see how music can cure or take care of this disease. I agree that music would give ability to elicit memories, motivations and positive emotions, then, I was wondering if everyone would have same effects for same music; I think it would vary a lot for each person’s personality and background. In other words, music therapist should know many types of music (classical, Jazz, pop, etc) and grasp the patient’s character. Moreover, since listening to music helps to release from stress, people should listen to music constantly to avoid dementia later on. While I was reading this journal, question popped in my mind, ‘then, musicians do not have to worry about encountering dementia?’ I have not researched for this question, but I think there may be some musicians who are suffering from dementia because dementia would occur from depression or heredity effect. Furthermore, it is very encouraging that involving or participating in learning music can help cure dementia. Later on, I hope successful establishment of its efficacy will allow us to conduct further translational research to understand how inexpensive and safe music therapy programs may be disseminated in the community. I am just surprised again by how music can role in such many ways.

Music & Religious Ecstacy


Penman, Joshua, and Judith Becker. "Religious Ecstatics, “Deep Listeners,” and
            Musical Emotion." Empirical Musicology Review 4.2 (2009): 49-70. Web.


            This study explores the connections between musical stimuli and strong emotional responses to music in the context of religious ecstasy. The basic hypothesis of this study is that people are physiologically pre-conditioned to respond to music thereby inducing a state of ecstasy. These “deep listeners” are a portion of musical consumers who experience a strong emotional response and have reactions to music similar to those of religious ecstatics. An ecstatic state is closely linked to the idea of a trance state: loss of a sense of self, a feeling of transcendence or connection with the divine and a lessening of self-talk. Trance states are often considered highly fraudulent or psychotic.  In some religious communities, overly charismatic, or “spirit-led” congregations are frowned up.
            For the purposes of this study, it is important to create a distinction between meditation and trance. Mediation is associated with a sense of stillness and mindfulness while trance is viewed as a very public sensual overload involving movement. Meditation is generally more accepted by Western societies while trance states have cult-like and fringe associations.
            This study examines physiological response to music using GSR (galvanic skin response) and heart rate monitoring. The study defines emotion as “relatively intense affective reaction that usually involves subjective feeling, physiological arousal, expression, action tendency, and regulation” (51). The participants for this study were divided into five groups: Pentecostal Ecstatics, Pentecostal Non-ecstatic, Other Protestants, “Deep Listeners” and General Students. The “trancing” or ecstatic Pentecostals were chosen out of a group of church-goers by the researchers on the basis of observation. They were people who were seen to enter states of speaking in tongues, interpreting tongues, or shaking and trembling visibly. The deep listeners were a self-selecting group of people, recruited from a music faculty, who believed themselves to be profoundly moved by music.
            Participants were asked to bring in two favourite songs to demonstrate their musical preferences. The first piece of control music was a classical piece chosen by the researchers while the second control piece was selected from the list of the participants’ favourite music. This is based on the idea that the physiological response to music is not a result of inherent features of the music itself but is found more strongly in the relationship of the listener to the music.
            During the experiment, both GSR and heart rate was measured while excerpts of the control pieces were played alternating with the selection from each participant. The highest readings for the GSR Index based on participant-selected music was the Pentecostal Ecstatics and the Deep Listeners. The deep listener group had consistently high readings on both the participant-selected and control group music. This could be a result of the musical training that all of the participants in this group had since by understanding the features of the music, there is perhaps a more profound emotional connection with the music.
            The authors also attempted to measure the correlation between the intensity of the music and the emotional response the music elicits. They devised a subjective measurement called Intensity Level or IL based on elements like the tempo, loudness, register and timbre of the music. This evaluation of the music revealed a moderately strong correlation between the GSR Index and the intensity level of each piece.
            Both the ecstatic and deep listener groups often describe their experiences in near transcendent terms – that they feel nearer to the sacred and that there is a loss of boundary between self and other. Overall, the results suggest that the Pentecostal ecstatics and deep listeners may have a different physiological response profile which seems to result in strong physiological responses to music. Effectively, the deep listener group may also contain potential ecstatics.


            This study provides a strong basis for future research into the connection between music and religious experiences. A broader exploration of other faiths could be helpful to establish cross-cultural links between music and religious experiences. However, it is evident from this study that music is really the catalyst for such religious experiences since trance-like states can also happen without music. In the sense of arousal, music may help people to focus their attention on one specific task. In the religious sense, that one particular task may be prayer or worship. Music heightens the sense of engagement with this particular task resulting in a type of hyperfrontality which leads to a flow or trance-like state.
            The one aspect that this study doesn’t explore is how personality influences the type of response to music. For example, it would be enlightening to see what personality traits the members of the Pentecostal Ecstatic group have in common. A personality test carried out in conjunction with this study would allow further conclusions to be drawn in terms of what types of personality traits make someone more predisposed to entering trance-like states.
            Overall, it is evident from the GSR results that a stronger emotional connection occurs when the listener feels some sense of connection with the music. In other words, the participant selected music always elicited a stronger emotional response than the control music chosen by the researchers. Both the deep listeners and Pentecostal ecstatics shared this strong emotional response. A further exploration of what makes these participants more predisposed to a strong physiological response to the music would be helpful. The personality trait data might also help in this regard. The fact that the deep listener group had a strong reaction to both groups of music (though the participant selected group was slightly higher) perhaps suggests that formal music training causes broader appreciation of a variety of styles. However, the fact that these participants were also classically trained musicians may also heighten their emotional response to the classical music selected as part of the control group.

            Lastly, it would be interesting to consider music’s impact on different types of ecstasy. Though this study has focused mostly on religious trance states, music also plays a role in stimulating meditative states. Both trance and meditation are just different types of transcendence. Different faith communities value both differently, and probably choose music specifically to invoke one of these states.

How the Adult Brain is Shaped by Musical Training in Childhood



This article was a study that investigated whether musical training during childhood leaves an enduring imprint on the adult brain. They tested 45 healthy adult participants between the ages of 18 and 31. The participants were placed in three groups based on their self-reported musical instruction; 0, 1-5 years, 6-11 years, and the male and female ratio was similar in all groups: 9/6, 9/6,  10/5 respectively. The groups also had similar IQ as measured using the Wechsler Abbreviated Scale of Intelligence, English Vocabulary and Matrix Reasoning.

The participant’s auditory brainstem responses (ABRs) were recorded to 8 triangle waves ranging in fundamental frequency: 262, 294, 330, 350, 370, 393, 416, 440 Hz. Each millisecond stimulus was presented binaurally 300 times in a pseudorandom interleaved design at 70 dB SPL via ER-3A insert earphones with an inter-stimulus interval of 38.43 millisecond. Participants sat in a reclining chair in a sound treated and electrically shielded booth. The ABRs were recorded using an analog to digital rate of 20kHz using a computer based hardware and software program. For each stimulus, the study obtained a signal-to-noise ratio (SNR) measurement calculated by obtaining a fast Fourier transform in MAYLAB 2011b.

After analysing the data, the study indicates that the musically untrained group had smaller brainstem responses (p<0.015), while the other musically trained groups had more robust brainstem response (p>0.2). However, the data illustrated that the musically trained groups had no difference. The average SNR of the brainstem response did not correlate with the amount of training, but it was inversely correlated with the amount of training. Although the study did not investigate the enduring behavioral benefits of childhood music training, we draw from prior work linking enhanced auditory brainstem encoding with heightened auditory perception, executive function and auditory=based communication skills to suggest that musical training during development may produce long-lasting positive effects on the adult brain.


The study shows that having any prior music training will alter the nervous system in ways that remain into adulthood. It also proves having music training during developmental stages in life may result in long-lasting positive effects on the adult brain.

This study is an excellent way to prove to schools that music programs are very important and can help with a positive development of the brain. Most of the participants in this study started music instruction at the age of 9, which is typically when teachers can introduce them to music at school. By offering music in schools, this will ensure that the majority of students will receive music instruction and improve their nervous system.

Even though the issue of surveying a very limited age range (18-31 year olds) was brought up in the survey, it is still considered recent as the participants received music instructions not too long ago. If similar data was displayed using those with older ages, then this can solidify the research data. If we can determine what type of music instruction was received by the participants, it will become easier for music teachers and the researchers to determine why musicians have a better development in the adult brain. The current data can help broaden our understanding of long-term neuroplasticity and have a positive impact of education policy makers and a positive development of auditory training programs.

Individual music therapy for depression: randomised controlled trial

Individual music therapy for depression: randomised controlled trial
  1. Esa Ala-Ruona. 2011
    British Journal of Psychiatry, 199:132-139.


Depression "makes us biologically older"
Michelle Roberts

 This study investigates the effect of individual music therapy on working-age (18-50) patients with depression. In particular, this publication set out to describe their methodology with greater clarity in regards to the clinical model, as the authors felt this was often lacking in other publications in this field.

 A few notes of interest from this publication's introduction are that up to 6.5% of the Finnish population suffers from diagnosed depression, and often verbal psychotherapy is insufficient, leading to the authors' investigation of music therapy as an additional treatment strategy. The reason this group investigated improvisational music therapy in particular is because it is considered a non-verbal method of  experiencing emotions and reliving memories.

Here, 79 adults with unipolar depression as a primary diagnosis were investigated. Anxiety was also described due to its high comorbidity with depression. Medication was continued throughout the study. Subjects were not excluded or included based on previous music training; however, repeated suicidal behaviours, acute, severe substance misuse, and psychosis were exclusion factors. The participants were randomized into two groups: standard care, and standard care with music therapy in a 10:7 ratio. Psychiatric evaluation was conducted at baseline, 3 months, and 6 months post treatment. These evaluations were done by a single clinical expert with extensive psychiatric experience, and no knowledge of which patient belonged to which experimental group. The study used the Montgomery-Asberg Depression Rating Scale (MADRS) to quantify primary outcome measures, which was calculated as a 50% or greater decrease in MADRS score. Similarly verified rating scales were used to measure secondary outcomes including anxiety, global functioning, health-related quality of life, and alexithymia (a disorder in which a patient has difficulty identifying and assessing internal emotions). The authors also measured electroencephalographic biomarkers; however, these were reported separately.

 Music therapy was administered in up to 20 bi-weekly sessions, lasting 60 minutes each, and the instruments used included a mallet instrument, a percussion instrument, and an acoustic djembe drum. The theory was that music therapy may be helpful in psychodynamic therapy since they both involve the expression of emotions, metaphor, and association and image.

 Changes in MADRS scores, and  in secondary outcome measures, excluding alexithymia, were significantly greater in the music therapy group, which persisted in the 6-month follow up assessment. Results were not effected by whether or not the patients self-described as musicians or singers, age, or medication. There was no significant difference seen in alexithymia, although there was a greater trend towards improvement with music therapy. This study employed 10 different, equally trained music therapists, and results were consistent among all individuals, which indicates that results were based on music therapy in general, as opposed to a particular therapist.

 In conclusion, this study effectively demonstrates that music therapy, in conjunction with standard treatment, statistically alleviates symptoms of depression, anxiety, and improves general functioning.

 As for the second article by Michelle Roberts, this article from BBC news briefly describes a possible cellular link between more rapid aging and depression, which further validates the medical need for intervention. This cellular link is found in the telomeres, which are chromosomal "caps" protecting the coding DNA from degradation after multiple rounds of replication. In depressed patients, these telomere caps allegedly shorten more rapidly, which increases the rate of genetic DNA degradation or "cell aging". This article was included to complement the above-described study.


 I was particularly impressed with this publication's outline of their clinical model, and meticulous approach in their experimental design. These qualities are often lacking in music therapy publications, as the authors themselves attest to in the introductory paragraph; however, this publication provides believable, controlled, statistically significant data, and a formidable model for future studies to build upon. This publication was a pleasure to read, and the results were very exciting. The authors reliably find a significant amelioration in depression, and secondary outcomes of patients engaging in music therapy. Also, the authors were able to assess 3 month and 6 month follow up outcomes, and found these improvements were maintained. This data has astounding implications for our current therapy paradigm, and suggests that music therapy should be a standard complement in depression treatment.

 I read Michelle Robert's article first, and it was what inspired me to ask if music can lessen depression. I had gone through several articles before choosing to write about this one. I found my choices were typically either a well-designed protocol outline, or a loosely controlled, poorly described study that directly investigated the effects of music therapy on depression. This article was the first, and most recent, that I could find that did both. I applaud Erkkila and colleagues for this work, and hope that future investigations on music therapy and depression will be forced to meet the same standards set by their precedence.

 As for limitations of this study, the authors themselves address them in the conclusion of the discussion. This study, although impressive with n=79, is still a preliminary trial that did not address every possible variable in music therapy. These variables include musical instrumentation, and frequency and duration of therapy. However, this study was a necessary building block from which more precise investigations can continue.

When right is all that is left:  plasticity of right-hemisphere tracts in a young aphasic patient.
L. Zipse, A. Norton, S. Marchina, G. Schlaug
Ann. N.Y. Acad. Sci. 1252 (2012) 237-245.

This article describes the use of a modified Melodic Intonation Therapy (MIT) intervention with an adolescent girl with severe non-fluent aphasia following a large left-hemispheric stroke.  This approach resulted in improvement in trained and untrained speech supported by Functional Magnetic Resonance Imaging (fMRI) revealing increased right hemisphere activity and Diffusion Tensor Imaging (DTI) scans indicating increased white matter volume in the right hemisphere.

To provide context for the article, MIT is an intervention developed by Sparks, Albert, and Helm [1] after noting that following a left hemispheric stroke, some individuals who develop aphasia have a preserved ability to sing.  MIT was developed using melodic contour and rhythm to support speech of short, trained phrases.

The authors used a modified version of MIT, adapted to the needs of the participant, LF.  The goals of the study were to:  “ 1) test the efficacy of our adaptation of MIT for a patient who did not meet the traditional inclusion criteria for this treatment; and 2) to investigate which structural and functional changes might support MIT-induced improvement when no viable left-hemisphere areas remain to support recovery of speech function.”

The participant, LF, experienced a large left-hemispheric stroke at the age of eleven.  As a result, LF’s speech was non-fluent, she had significant word-finding problems, and impaired repetition ability.  Her comprehension ability remained high.   Standard tests were used to measure these areas with results comparable to Broca’s aphasia.

The authors used 3 baselines, measuring improvement in trained and untrained phrases at the midway, conclusion, and one-month-post treatment times. 

Treatment was intense, with five 1.5 hour sessions per week for 16 weeks. Treatment was divided into two phases.  Both phases included two levels of difficulty.  Phase one included target phrases of varying syllable lengths.  Phase two added a focus on syntax.  The authors provide a detailed description of their treatment and measurements.

Results indicated improvement in both trained and untrained phrases.  Improvement was most notable on trained items.   These functional results, and additionally LF’s improved speech fluency, were supported by family observations during treatment. 

fMRI imaging revealed an increase in activity in the right posterior middle frontal and inferior frontal areas from baseline to mid-point of treatment but followed by a return to baseline level.  This reduction in activation may have been a result of increased efficacy of these regions. 

DTI scans revealed white matter increase in the right hemisphere arcuate fasciculus (AF), a fiber track connecting the superior temporal lobe and the inferior frontal gyrus and motor/premotor regions, and in the uncinate fasciculus (UF).  In the left-hemisphere, these tracks are believed to be associated with speech and language processing.

Following treatment LF’s speech continued to include aphasic qualities but with improvement, most notably, in fluency. 


Two main points were significant to me as I read this article. 

First was the strong evidence of the efficacy of music-supported interventions to address speech rehabilitation goals.  Although there is currently a solid research base of this evidence, this article particularly caught my attention due to the results of improved speech in spite of such extensive left-hemispheric damage.  The authors noted in their conclusion that some researchers suggest a greater unilateral injury (rather than a smaller lesion) may more effectively result in hemispheric transfer and therefore potentially increased rehabilitation outcomes. This is noteworthy to me, as my client population is primarily individuals with severe brain injury.  In the face of significant deficits, it is encouraging to note that there remains the potential for response to therapeutic interventions and in this case, particularly ones that are music-based.  This potential for response of course is dependent on many factors, including lesion location, pre-injury condition, intensity of therapy, and other individualized contributors.  Also, the young age of the participant in this study would be a factor in her improvements.  Prior to the modified MIT approach, LF had received 15 months of speech therapy.  It is notable that using a music-based intervention resulted in further improvements evident both in functionally and in neural changes observed in fMRI and DTI imaging.

Secondly, I was intrigued by the neural plastic response of the AF and UF with increased white matter.  The participant’s AF and UF function in the left hemisphere was damaged and this was indicated by her aphasic symptoms.  It was extremely interesting to me that as her speech ability improved, these areas in the right-hemisphere increased in density.  Speech is typically supported by regions in the left hemisphere.  The hemispheric shift to support speech and the increased AF and UF density was quite striking.  The wonder and the potential of neural plasticity begs many questions, yet this article provided me with encouragement as a music therapist working with individuals living with the affects of acquired brain injury. 

1.  Sparks, R., N. Helm & M. Albert. 1974.  Aphasia rehabilitation resulting from melodic intonation therapy.  Cortex 10: 303-316.

Singing effects in Neurological Disorders

The Therapeutic effects of Singing in Neurological Disorders
CATHERINE Y. WAN, THEODOR RÜBER, ANJA HOHMANN, AND GOTTFRIED SCHLAUG Beth Israel Deaconess Medical Center and Harvard Medical School (2010)
Music Perception: An Interdisciplinary Journal, Vol. 27, No. 4 (April 2010), pp. 287-295

 This article reviews recent evidence on the therapeutic effects of singing in reference to speech problems, Parkinson’s disease, brain lesions, and autism. Singing as a therapeutic approach to treat neurological disorders is not a new idea, but one that is growing in recognition given the similarities between singing and speech, and the neural correlates of both (287).

Active music making, including singing or playing an instrument, obviously creates different demands on our neurological pathways than the act of listening to music. These additional demands on the nervous system lead to a strong pairing of perception and action, connecting a musical action to the sensory and motor parts of the brain. In this article, the authors show a figure of the difference in size between the right-hemisphere fiber tract (connecting auditory with motor regions of the brain) of a professional singer and a participant who sings only occasionally. In the diagram it is clear to see the difference in size between the two. Unlike other forms of music making, singing is a particularly valuable therapeutic tool not only because of its connections to speech, but also it engages this auditory-motor feedback exercise in the brain more readily (288).

The first neurological based disorder looked at in this article is stuttering. The authors of this article review several studies that have been done in the past thirty years on the therapeutic use of singing and stuttering, specifically how the use of familiar songs can help in speech flow of the individuals. In 2003, a neuroimaging study was done on the these effects, and it was found that the areas of the brain that were active in fluent speech (singing) and in dysfluent speech (reading unknown sentence) were the same areas of the brain involved in both motor/pre-motor regions as well as the sensory/auditory areas. This study showed that the act of singing (or fluent action of sound/speech) produced more activity in the left hemisphere of the brain, suggesting that this can help create fluency (289).

Further, this article reviews the effect of singing on both Parkinson’s disease and Aphasia, coming to similar conclusions. In Parkinson’s Disease, 80% of individuals diagnosed develop some sort of speech problem including: breathiness, lower volumes of speech, and short phonation time (290). The LSVT (Lee Silverman Voice Treatment), is a treatment that already exists to help reduce some of the problems associated with Parkinson’s Disease. Others have used singing and singing exercises specifically as a way to improve phonation and breath abilities of these patients, and have seen the long term effects of this work. In relation to Aphasia, much more has to do with the locations in the brain of injury. Fluent aphasia results generally from a lesion involving the posterior superior temporal lobe (Wernicke’s area). These individuals generally have severe speech comprehension problems (290). In contrast, nonfluent aphasia mainly affects the left frontal lobe and left posterior inferior frontal region (Broca’s area). These individuals generally have good speech comprehension skills, but have problems when it comes to speech production.

In the diagram of the brain, the authors show that through singing training and specifically melodic intonation therapy (MIT), that the fiber tract connecting the auditory and motor regions of the brain can strengthen.

Through these studies, the authors illustrate the ways in which singing is not only simply therapeutic, but helpful in neurological processes. In the physical manifestation of speech problems, singing helps with the connectedness of words and syllabic delivery. Secondly, singing engages a “larger bihemispheric network” (297) than simply speaking, which primarily engages the left hemisphere, helping create a use of other working area of the brain. Singing can help with the idea of sound-motor mapping, and this is particular helpful to these disorders that are connected to an articulartory-motor component.

At the end of the article, the authors clearly state “Taken together, there appears to be a number of possible mechanisms underlying the efficacy of singing in ameliorating the symptoms of various neurological conditions” (291).

What I found so interesting about this article was that I always thought of music and singing as therapeutic, but to think of singing as a specific tool to help develop and grow connecting pathways in the brain was so interesting to me. 

While I was doing my undergraduate degree, I worked part-time with several kids with developmental disabilities. Several of the clients I worked with had severe cases of autism, and I could see the effects of music on them. Of course, each individual is so different, but I worked primarily with one boy (about 10yrs old) who had a very limited vocabulary (maybe 30-40 words), but seemed to have a generally high level of comprehension. Whenever we would sing familiar songs with him, he would often input some words in the song that he would generally never use in speech, even when prompted. This idea of singing being something that can help create avenues for speech is quite interesting to me. The diagram in the article (which I tried to post in this blog, but it wouldn’t copy correctly), is what made it very real to me that there is physical healing in singing, not simply an emotional release, or just all ‘fun’, but legitimate healing and growth of brain (and therefore body) abilities and functions. In a way, this gives me a new appreciation for singing, and the holistic healing that it can give.

Monday, November 11, 2013

The Therapeutic Effects of Singing in Neurological Disorders

Wan, C. Y., Ruber, T., Hohmann, A., & Schlaug, G. (2010). The therapeutic effects of singing in neurological disorders. Music Perception, 27(4), 287-295. doi: 10.1525/mp. 2010.27.4.287.

This article, published in Music Perception in 2010, summarizes research on the use of singing to treat various neurological disorders that can cause language and motor impairment. I am especially interested in this research because it focuses on active singing by patients, as opposed to music listening. Singing utilizes multiple areas and systems of the brain, which can help to rebuild connections and skills in patients who may have lost abilities due to neurological conditions. As the article puts it: “Unlike music listening, active music making places additional demands on the nervous system, leading to a strong coupling of perception and action; processes that are mediated by sensory, motor, and multimodal integrative regions distributed throughout the brain.” The authors point out that “[s]inging in particular can serve as a valuable therapeutic tool because it is a universal form of musical expression that is as natural as speaking.” Although some of my students may disagree with the “natural as speaking” portion of that statement, it is true that singing in one way or another is universal to almost everyone. Most people sing, even if it is only in the privacy of their own homes, whereas learning an instrument takes a certain amount of extra investment in the form of purchasing the instrument, learning the physical movements, etc. Singing at an expert level requires just as much training, but unlike, say, the violin, making recognizable music with some level of fluency is something that most people can do right away with their voices. 

All of this points to singing as a natural way for patients in recovery from a neurological disorder to participate in music making. Singing itself also has some distinct benefits that are not found with other instrument groups; it shares a network in the brain with speech, and engages an auditory-motor feedback loop in the brain. Additionally, singing has some straightforward physical benefits. One study found that singing lessons were beneficial to patients with chronic obstructive pulmonary disease. Patients who took singing lessons showed greater inspiratory capacity and higher maximum pressure on exhalation. In these patients, singing appeared to strengthen the muscles of the respiratory system.

The paper covers four neurological conditions that have been shown to respond to singing as treatment: stuttering, Parkinson’s disease, aphasia, and autism. In the case of stuttering, which is characterized by interrupted speech, repetitive sounds, and an inability to speak with fluency, the act of singing seems to help patients who stutter to smooth out their speech and speak fluidly. According to one study, singing helped to increase fluency by 90%. This may have to do with the elongation of sounds and the increased control of speech articulators (lips, tongue, etc.) that is typical of singing. Another study found that fluency-inducing tasks (such as singing) causes activation in parts of the brain related to speech processing and motor articulation. 

Parkinson’s disease is a devastating condition that manifests in a variety of ways, one of which can be a loss of control over speech. Patients may experience poor vocal quality, a decrease in speaking volume, or interrupted speech, among other symptoms. According to the article, preliminary data indicates that patients with Parkinson’s who practiced vocal warm-ups and singing exercises, as well as those who engaged in group choral singing of chants, showed improvement in vocal quality, reading, and speech intelligibility. These results were observed with small sample sizes but are encouraging nonetheless.

One fascinating use for singing therapy is with patients experiencing aphasia, or loss of speech due to stroke or other brain injury. When used as treatment for this condition, singing seems to actually rebuild or strengthen sections of the brain. As an example, the article names the arcuate fasciculus (AF), a  bundle of fibres that is involved with auditory-motor mapping and language processing. The left bundle is especially associated with language, and is larger in most healthy people; however, trained singers also show an enlargement of the right bundle. Melodic intonation therapy (MIT) has been shown to increase the right AF in patients whose left AF has been damaged by stroke. This, along with other right-hemisphere changes that can occur as a result of MIT, can cause significant improvement in the patient’s ability to process language and to speak.

Lastly, the article discussed possible applications of singing therapy for individuals with autism. As of the time of publication of this article, only two case studies had been reported; however, both indicated that singing therapy could help these individuals develop and strengthen language and communication skills. Further research is needed in this area.

As a singer myself, I cannot help but have a personal reaction to the research described in this article. Like almost any professional musician, I entered the field of music because I loved it, following a passion that seemed to defy description in its intensity. And like almost any graduate of a university or conservatory music program, I made the decision to try to become a professional musician at a young age, when I began to audition for various undergraduate programs as a teenager. At that age, the personal rewards of music-making were my motivation; it was enough that I loved it, that it satisfied me. It didn’t occur to me that I would ever want more than that intrinsic reward. 

It has now been more than ten years since I made that decision, and while I am indeed a professional musician of sorts (some combination of “young professional,” “emerging professional,” “semi-professional,” and “student”), I have found that my motivations for music-making have fluctuated over time. While it was once enough to sing in order to satisfy myself, I now frequently wrestle with the question of what music actually does in the world, and what musicians can contribute. What good can I do by possessing a highly-trained vocal instrument? Could I have offered more if I’d chosen a different vocation? In short, does music actually help anyone?

In light of this question, it’s incredibly encouraging to read about how music, and my own instrument specifically, can help people struggling with some very difficult conditions. While I firmly believe that listening to music can be a powerfully uplifting, moving, and healing activity, I am also excited to know that the act of singing seems to directly relieve suffering, at least in some individuals and under certain circumstances. This article made me eager to know more about what is involved in working with some of these patients. Clearly the therapies used have been carefully designed and would be different than simply teaching a voice lesson to a student; however, I wonder what the roles are for trained singers and voice teachers in this type of work. Whether or not there is space for singers such as myself to engage with this work in any way, I am heartened by the idea that singing can help some of these individuals develop, strengthen, or regain the ability to communicate with those they care about - which is, after all, the point of music in the first place.