Perfect Harmony

Elias Gefen was 87 years old when he first tried playing an electronic drum set. He had never had music lessons in his life. He was in pretty good shape for his age – he used an electric wheelchair but could still walk when needed and was independent enough to come to some sessions on his own. His mind was still sharp, but since suffering a stroke four years earlier, he hadn’t had the full use of his left arm or leg. So when Takako Fujioka, a neuroscientist, asked him to play the drum set using his bad arm as well as his good, Gefen was skeptical. But he gave it a go.

That first day, his entire body had to move toward the eight-piece drum set to bang out a sound with the bad arm. Fujioka had to find pillows to support his elbow, but he kept at it for the whole 30-minute session. By the third session, the pillows were no longer needed. By the eighth session, he could reach all the drums, even the one in the middle that required a 30-centimetre reach. Soon, he was beating out complex sound sequences, alternating between good and bad arms and among drums. “I couldn’t stop him sometimes,” recalls Fujioka. “He was really into the groove.”

By the end of the 15th and final session, Gefen was able to move the damaged arm around the full circle of drums with precision. What’s more, it felt stronger, he told Fujioka, and he was able to do more on his own at home.

Gefen was taking part in a pilot project at Baycrest, a University of Toronto–affiliated research facility that focuses on aging and brain health. The researchers, Fujioka and fellow neuroscientist Bernhard Ross, who is also a professor of medical biophysics at U of T, were looking into whether simple musical training could help bring limbs damaged by stroke back into use. They worked with three patients, all of whom improved. While Gefen worked with the drums, another patient worked with drums plus keyboard and a third with keyboard alone.

Music can sometimes be the perfect medicine. Not only is it fun and motivating, says Ross, but it requires patients to be precise in their movements and to apply the right force with exact timing. It provides immediate acoustic feedback so they know right away how they’re doing. And it turns out that in the act of producing it, patients can reshape their brains – even when they are pushing 90.

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Ross and Fujioka are part of a growing trend in research that is exploring how music can be used in health care. Sometimes, as in this pilot project, music-making is the treatment. Other researchers are experimenting with listening to music as a means to alter brainwaves in order to ease pain or fatigue. Still others are testing whether sound vibrations absorbed through the body can ease the symptoms of Parkinson’s disease. Soon these researchers and others will work together under the umbrella of the new U of T Music and Health Research Collaboratory, which will open its doors in July and be in full swing by September. The centre’s headquarters will be at the Faculty of Music, but it will operate mostly as a virtual institute, with collaborators continuing to work from their established labs.

Humans have experienced the mood-altering power of music for eons. Lullabies soothe children. National anthems stir collective pride. But one of the primary goals of the new centre will be to investigate how music and sound affect people’s health. The researchers will try to understand the mechanisms behind the body’s specific responses to music and sound, says Lee Bartel, the faculty’s associate dean of research, who in many ways has been the driving force behind the new facility.

In all, the centre will have four overlapping areas of inquiry. These include music as therapy and medicine, the importance of music to the connection between body, brain and mind, the role of music in keeping societies and cultures healthy, and the health and science behind teaching, learning and performing music. U of T will offer Canada’s first doctoral program in music and health, and the first research-oriented master’s degree in the field. One of the centre’s key strengths is that it will bring together scientists doing research with clinicians able to apply it. Too often these people work in isolation, says Bartel. “Very little of the neuroscience in this area has led to clinical treatment,” he notes.

Ross and Fujioka received a grant in January from the Canadian Institutes of Health Research to take their pilot study further, and they are now recruiting 60 patients for a full study. The team, which also includes Baycrest senior scientist Deirdre Dawson, will be testing an intriguing hypothesis: that the auditory system can be enlisted to help get the motor system going again.

Many stroke patients suffer damage to the brain’s motor system, but the auditory system is usually left intact, says Ross. So while the connections between a hand and the parts of the brain that control its movement may be disrupted, there may be another pathway running between auditory and motor areas. “If you synchronize auditory input with the movement of the hand, you might be able to employ this second pathway,” he says. So, just as a metronome helps you master timing, and a soundtrack helps you keep in tune, the sound of a drum may make stroke patients better able to control movements of a once-errant limb. These meaningful inputs can help the brain change.

Results from the pilot project support that idea. As part of that study, the researchers used a brain-imaging technique called magnetoencephalography, or MEG, to compare the sensorimotor maps in healthy people’s brains with the brains of their three patients. In healthy people, applying a stimulus to each finger lights up an area in the brain very close to the areas lit up by the stimulus on the other fingers. In the stroke patients, this was not the case. Finger activations were sometimes out of order in the brain, for instance, or in the wrong spot altogether.

Remarkably, though, after 15 sessions of musical training, even years after the initial stroke damage, the brain begins to right itself: the activations more closely resembled what happens in healthy people. “They were closer to normal after the training,” says Ross. The researchers’ work will be published in the Annals of the New York Academy of Sciences.

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Patients who make music or sounds seem to recover better, but those who “feel” sound vibrate through their body might also improve. This is a line of inquiry being pursued by Heidi Ahonen, a psychotherapist and professor of music therapy at Wilfrid Laurier University in Waterloo, Ontario, who will also be affiliated with U of T’s Music and Health Research Collaboratory.

Ahonen has been working with a special “physioacoustic” chair, designed and first used in her native Finland. At first glance, it looks like an ordinary recliner. But it’s fitted with six loudspeakers, one behind each knee, two in the lower back area and two in the shoulder area, which work together to circulate vibrations evenly around the body. The speakers are hooked up to a computer and software, which allows Ahonen to choose the exact frequency she wants, usually around 30 Hz – a very low-frequency sound that’s barely audible. It is believed that the vibrations can be made to resonate with the muscle or tissue that the practitioner is trying to treat.

The physioacoustic chair so far has not been approved for medical use in Canada, but the U.S. Food and Drug Administration has sanctioned it for three treatments: reducing pain, improving blood circulation and relaxing muscles. Elsewhere in the world the chair is used for stress relief, drug rehab and psychotherapy, among other things. Many of Ahonen’s own private clients from a previous practice in Finland came to see her about pain – post-surgical pain, for instance, or fibromyalgia – but some also seek relief for other ailments, such as Alzheimer’s disease and the damage caused by stroke. So Ahonen was enthusiastic when Quincy Almeida, a neuroscientist at Wilfrid Laurier University interested in Parkinson’s disease, approached her to collaborate in a study on whether the chair could improve the disease’s symptoms.

Parkinson’s disease is a neurological disorder caused when brain cells that produce dopamine are slowly destroyed. This results in tremors, as well as difficulties with walking, movement and co-ordination. Scientists don’t know exactly why the chair might help relieve these symptoms but some have theorized that certain frequencies of vibration might be stimulating part of the brain involved in Parkinson’s.

Forty Parkinson’s patients participated in Ahonen and Almeida’s study. It compared the effectiveness of treatment versus just relaxing in the chair. Each participant did both; half rested first, and half had the treatment first. For the treatment, Ahonen exposed the patients to the low-frequency 30Hz vibration for one minute, followed by a one-minute break, in alternation for a total of just 10 minutes. For the rest phase, the patients sat comfortably in the chair, relaxing.

They were assessed in three ways. First, the patients were videotaped and rated for tremor, finger-tapping, leg agility, posture and their ability to stand up from a seated position. They were also asked to walk in a straight line at a normal pace down a carpet that could measure step speed and length. Finally, they were timed while inserting and removing special keyed pegs from a board. They were assessed at three time points: at baseline, after treatment and after resting.

Ratings of both rigidity and tremors improved significantly after the vibration treatment, the researchers found. So did step length. They also got pegs into the board more quickly – taking an average of just 170 seconds to do so, compared to 210 seconds before the treatment. The researchers published the work in the journal NeuroRehabilitation. “It was encouraging to see changes after so short a time,” says Ahonen, “but we don’t know if it lasted. We need to do a long-term study.”

A more in-depth study on the chair’s effect on Parkinson’s is one of the aims of U of T’s new centre. “What if we did it three times a week?” asks Almeida. “Or for an hour instead of just five minutes?” He admits he was a skeptic at first, but is now curious to see if tailored use of the chair can help patients overcome some of their symptoms without the need of so much medication.

Ahonen is also excited about what the chair might have to offer people with Alzheimer’s. One incident in particular stands out for her. A female client was in the chair, receiving vibrations at 40 Hz. Ahonen noticed that the woman’s husband was speaking intensely with her and at one point was crying. Afterwards, he told Ahonen that his wife had just recognized him for the first time in years. She had also remembered the names of their children and the couple was able to talk about how the children were doing.

“Maybe it’s possible to recreate this,” Ahonen says. She has since learned that 40Hz may affect a region of the brain called the thalamus, which is reduced in size in Alzheimer’s patients. She hopes that, by working through the Music and Health Research Collaboratory with a team of neuroscientists interested in the effects of music and sound on the brain, she can explore how the chair is affecting Alzheimer’s patients and how it can be used to greatest effect.

Listening to music in more conventional ways may also hold promise – in relief for patients with fibromyalgia, a poorly understood disorder. Its hallmark symptoms are pain, fatigue and disturbed sleep. Once believed to be a disorder of the connective tissue, some doctors, such as Larry Picard, a neurologist at the Wasser Pain Management Centre at Mount Sinai Hospital and an instructor in U of T’s department of medicine, now believe it to be related to the central nervous system. “Increasingly, data support the view that fibromyalgia is a condition of disturbed or disordered pain processing in the central nervous system,” he says. “Why it happens is unclear.”

“The current treatments are all less than adequate,” adds Picard. These include medication, exercise and psychological support. “We’re trying to look at other ways to help these people.”

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Picard surmises that the sleep deprivation and the pain might be feeding into one another, and creating a vicious cycle. “If people are deprived of sleep, they will feel more pain,” he says. “If they feel more pain, they can’t sleep.” So he has teamed up with Bartel to try to tackle the sleep side of the equation first.

For some years, Bartel has been designing music that can influence a person’s brainwave activity. The music, which is commercially available on the Solitudes label, typically combines sounds recorded in nature with soothing instrumentals. The music is affordable, painless and drug-free – and, according to EEG evidence that Bartel collects for each new CD, it significantly increases the brainwave activity associated with sleep.

In a pilot study on fibromyalgia, which just got the go-ahead this spring, 20 patients will use the music at night for a month to try to improve their sleep. They will document when they use it and will fill out a questionnaire at the beginning and end of the study, in an attempt to measure music use, pain levels, sleep success and whether there are any correlations. There will be no brainwave analysis at this point and no placebo-controlled arm to the study. But if they find it helps, the researchers intend to take it further. Traditionally, music research has been more art than science, says Bartel. Now, the Music and Health Research Collaboratory promises to put some scientific heft behind that wealth of observation, examining not just what music does to the human body and psyche – but how it does it.

Alison Motluk (BA 1989 TRIN) is a journalist in Toronto.

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The first audio clip below is an example of a “vibroacoustic sound” similar to what was used with Parkinson’s and Alzheimers patients at the Music and Health Collaboratory. This sample adds a sound two octaves higher that has been treated with 40Hz amplitude modulation – in essence turning the sound on and off 40 times a second. This makes it audible and gives a sense of the treatment.

Download Sample One

The following clip is from “Music to Promote Sleep,” which is being used for sleep induction in a fibromyalgia study at the Wasser Pain Management Centre in Toronto. It features a 2 Hz delta brainwave entrainment technique.

Download Sample Two

The final clip is from a SonicAid album called “Music to Improve Relaxation.”

Download Sample Three