When the audience clapped at Steinmetz Hall in the Dr Phillips Centre for Performing Arts in Orlando, Florida, they weren’t aware that five of the percussion ensemble on stage were stroke survivors. Yet they didn’t slip a beat on their cabasas, drums and djembe. What the audience also didn’t know was that the performance was part of a music therapy session, music being proven to activate various centres of the brain.
As one of the participants said, “My emotional well-being is through the roof because of this.” And he drew succour from the fact that there were others like him in the group, who felt energised by association as fellow survivors of what could have potentially killed them.
The five stroke survivors and their families were working with musicians from London’s Royal Philharmonic Orchestra (RPO), which in partnership with Hull and East Riding Community Stroke Services, part of an NGO in the UK named City HealthCare Partnership, has specially adapted musical techniques to address the complex needs of stroke survivors and their care-givers.
The Royal Philharmonic Orchestra’s special programme, called Strokestra, began with an intensive research and development phase and was piloted as a five-month programme in 2015. Researchers found significant improvements in patients, care-givers and staff after they learnt piano, drums and violin and interacted with musicians.
The programme implementers claimed that 86 per cent of patients were relieved from disability symptoms and actually had improved sleep, reduced anxiety, fewer dizzy spells and reduced epilepsy symptoms. Ninety-one per cent reported social benefits such as improved relationships and communication skills, 86 per cent found cognitive benefits, including increased concentration, attention and memory, 86 per cent improved emotionally, citing increased confidence, morale and sense of self while 71 per cent improved physically, including walking, standing, upper arm strength and stamina. But what stood out from the data sheet was that 100 per cent caregivers reported an improved relationship with their patients. Although researchers don’t yet fully understand how it happens, MRI studies have shown that music therapy improves brain plasticity. Brain plasticity refers to changes in the structure of the brain.
According to Dr Amit Jain, Consultant Pain and Palliative Medicine, Dharamshila Rahat Supportive and Palliative Care Centre, says that music therapy is a simple, safe and easy rehabilitative routine for stroke survivors. It promotes the recovery of cognitive functions, helps improve dysphagia, facilitates limb motor exercise training and promotes speech recovery.
As aphasia is a common consequence of a brain stroke among Indians too, music therapy can be quite effective as a treatment protocol. There have been examples where individuals, who struggle with their speech, can often be able to sing, says Dr Jain. “After a stroke, a part of the brain gets affected and eventually functions that were controlled or regulated by that part slow down or stop. When you listen to music, its rhythm and beats try to re-train or rewire the brain in what is called neuroplasticity. Music therapy helps in recovering those functions to some extent,” explains Dr Jain.
He adds that any patient who has suffered a chronic stroke with difficulty in upper extremity function or coordination of limbs should take piano classes. Whether all stroke individuals will respond similarly to these classes or gain through them remains unknown but they can still be tried for better functional levels of motor recovery.
“Music releases endorphins which give you a feeling of excitement, calm your anxieties and stabilise your pain and immune system, all of which control depression. Music connects with your autonomic nervous system, which stabilises your blood pressure and heart beat,” adds Dr Amit.
Meanwhile, Dr Praveen Gupta, Director of Neurology at Fortis Memorial Research Institute, says it is still questionable whether music therapy will lead to structural architecture and changes in the brain, which are a part of brain plasticity. He argues how these studies talk largely of physical well-being, increased socialisation and overall sense of wellness which any socio-cultural activity, including music, will provide. “The music-based studies conducted under the programme are actually dealing with the patient’s felt outcomes rather than objective stroke improvement outcomes, which can be assessed on cognitive or physical tests. There is a lot of subjectivity and bias and it would be better if further studies on the impact of music on stroke recovery are based on more objective criteria. Theoretically any learning task will stimulate brain function and will lead to brain plasticity,” says Dr Gupta. “Doing any coordinated physical activity will lead to functional benefits of the brain, regardless of whether it is injured or healthy. I reiterate that brain plasticity, which refers to the change in brain functioning, is better evaluated by functional imaging of the brain rather than just plain MRI,” he adds.
Dr Gupta says that if an injured brain is taught language, writing or music, it will lead to a change in brain circuitry, giving rise to neuronal plasticity. However, a PET scan will be much better to evaluate brain plasticity than an MRI scan because the former is able to do functional neuro-imaging while most MRIs are able to do structural neuro-imaging.
“It is to be noted that the area of music and speech are not the same. That is why people who stammer can sing flawlessly. The study clearly emphasises that a lyrics-based therapy versus instrumental therapy had better effects and led to stimulation of sensorimotor-integrated pathway for language, which is possible,” he adds.