Episode 3. Music As Medicine

How would you react if you went to a medical specialist and, instead of pills, they prescribed you singing, drumming, and other forms of music making?

I asked scientist and certified neurologic music therapist Dr. Kyurim Kang of the Johns Hopkins University School of Medicine to describe music therapy, how it works, and some therapeutic activities that they offer.

01:27  Can you tell me what you study?
 
02:08  How did people come up with the idea of music therapy?
 
02:53  Is there scientific evidence that music therapy improves conditions of patients of neurodegenerative diseases?  If so, what are some of the signs of improvement?
 
06:36  Can you tell me about the clinical trials such as ParkinSonics, Guitar-PD, and Drum-PD that are conducted at the Center for Music and Medicine at Johns Hopkins University School of Medicine?
 
08:45  Is group therapy more effective than doing it on one's own?
 
09:38  Do the guitar, drum, and singing therapy only work for Parkinson's patients or do they work for other conditions also?

12:06  How do you measure the effectiveness of a particular therapy?
 
15:28  For people who can’t travel to the institute, are there other ways they can still benefit from music therapy?
 
16:30  For someone who wants to pursue music therapy, what advice do you give them?

ABOUT SCIENCE, MUSIC, AND SOCIETY PODCAST
A show that explores the intersection of science and music and their benefits to society through personal stories of scientists and musicians.

You can watch the entire video podcast on YouTube at https://youtube.com/playlist?list=PLc83Bpg8hEEHuEXWk7qIJm2SbUMbww74j or listen to the audio podcast at https://ScienceMusicAndSocietyPodcast.buzzsprout.com

ABOUT SOPHIA SI
A high school senior in Houston, TX, who grew up playing the piano and loving science.

ABOUT KYURIM KANG
PhD, licensed professional and board certified music therapist and neurologic music therapist, and Postdoctoral Research Fellow at the Center for Music and Medicine in the Johns Hopkins University School of Medicine (https://www.hopkinsmedicine.org/dev/center-for-music-and-medicine/team.html, Instagram:  https://www.instagram.com/jhmusicmedicine/, Facebook: https://www.facebook.com/hopkinscmm, Twitter:https://mobile.twitter.com/jhmusicmedicine).

RESOURCES

Due to space limitations, check out the Science, Music, and Society Podcast show page on YouTube at https://youtube.com/playlist?list=PLc83Bpg8hEEHuEXWk7qIJm2SbUMbww74j for links to relevant publications, contact information regarding  virtual ParkinSonics Choral Group, Drum sessions, Neurology music therapy support group offered by the Center for Music and Medicine at the Johns Hopkins University School of Medicine, and more.

Transcript

TRANSCRIPT (CONDENSED and NOT ENTIRELY VERBATIM) 

Sophia Si:

Hi, this Sophia Si, and welcome to another episode of Science, Music, and Society. 

When we think of treating medical conditions, we usually think of medicine in the form of pills, but scientists have also learned to use music therapy as a way to alleviate symptoms and restore neurological function.  For example, patients suffering from Parkinson's disease, a movement disorder, can have difficulty walking.  However, the sound of rhythmic music can dramatically convert this unsteady walk into a normal gait.  <video from https://www.youtube.com/watch?v=oTjIEtpR4yU, showing gait without and with rhythmic music>

Patients who have damage to the Broca's area, a region on the left side of the brain involved in speech production, have difficulty articulating words. Many, surprisingly, can still sing these same words.

 <video from https://www.youtube.com/watch?v=tiJ9X_wLSWM showing former Arizona Congresswoman Gabby Giffords having difficulty saying  the word “light” but was able to sing it>

Neurologic therapists work with them to first hum, and then sing, and then finally to speak the words they wish to express. This strategy is known as melodic intonation therapy, and it successfully helped former Arizona Congresswoman Gabby Giffords improve her ability to speak.

To learn more about the role of music and medicine, I chatted recently with my guest, Dr. Kyurim Kang, a scientist and neurologic music therapist at the Center for Music and Medicine at the Johns Hopkins University School of Medicine.

Sophia Si:

Hi Kyu, and welcome to Science, Music, and Society. So excited to have you here today. Just briefly, in a sentence or two, could you tell us what you study?

Kyurim Kang:

I'm investigating how brain activities (of patients with neurodegenerative diseases) are changed during the music therapy sessions as a researcher. And as a music therapist, I'm leading individual and group neurologic music therapy sessions to improve some functional performance in sensory motor, cognitive, and speech and language domains for individuals with the neurodegenerative disorders such as Parkinson's disease, Huntington's disease, and Alzheimer's, and so on.

Sophia Si:

Wow, very cool. How do you think that people came up with the idea of music therapy?

Kyurim Kang:

Yeah. Historically, in ancient tribes, we used music to improve social cohesion. In the US, starting from after World War II, music has been used as a therapeutic medium to heal traumatic experiences. Thanks to technological advances, we can now observe how our brain works and how music is processed in the brain. That helps us to understand why and how music therapy is effective to specific populations.

Sophia Si:

Would you say that there is scientific evidence that music improves the conditions of patients suffering from these neurodegenerative diseases? And if so, what are some of the signs of improvement that you can see?

Kyurim Kang:

That's going to be a long story. I would highlight using music for language skills using common and different brain mechanisms. By putting the information we need to learn into a melody, we can memorize and recall more easily. And this might be due to the prediction principle, because we know the next pattern of music, and this primes and boosts the next information that you need to memorize or recall. The brain mechanisms of prediction and anticipation can also be relevant.

And as sound shapes the word language shapes, we can produce the speech with a simple or familiar musical pattern. For example, there's a melody intonation therapy which uses melody, intonation, and rhythm to restore the language skills for Broca's aphasia, for after strokes.  Broca's aphasia is the damage of the Broca's area in the left brain regions, and Broca's area is responsible for the speech production. People with Broca's aphasia have extreme difficulty producing the natural prosody patterns.

So for example, if we want to work on (articulating)  "How are you today," maybe we can start humming, "How are you today?" We can start humming. Emphasize the syllables with the higher notes because this is a question sentence, so maybe we can use the ascending scales as a humming. And this sentence can be trained after humming. You can exercise with the exact sentence with the melody, "How are you today?" And there would be some repetition with the patients, and you can gradually fade your humming and sound so that the patient can produce this sentence by themselves.

And not only for memory in the brain, but the rhythm processing is also very important. During this protocol, the therapists have the patients to do the tapping with their left hands so that they can activate the contralateral side (meaning the right side of the brain), activating the right sensorimotor networks more so that speech production can also contain movement, motor aspects, so that this activated sensory motor area can promote your movement as well, like speech production.

So there's a lot of brain mechanism as I have mentioned. There's a prediction and brain plasticity, because by boosting and activating another area, they can bypass (the damaged area) and trigger the healthy areas  to compensate for the damaged area. I know this was a long answer.

Sophia Si:

Oh no, that was great. So it's like a workout for the brain, basically?

Kyurim Kang:

Yeah.

Sophia Si:

Okay. And that actually leads to my next question. So I did read about some of your clinical trials, such as I know there's ParkinSonics, and then you have your guitar PD, drum PD. Could you tell me a little more about those?

Kyurim Kang:

Sure, yeah. Because we are doing not only research, we also do music therapy. And not only for the internal referred patients, we wanted to provide a service to the community, as well. So definitely for Parkinson's disease, as I mentioned, the rhythmic pattern is pretty important to give them some specific auditory cueing. And so I can give you the context: Jason, who's the music therapist, he's providing the community drum via Zoom. Because of the pandemic, they meet once a week so that they can have the rhythmic remedy for drumming. He has assignments. For example, you need to this (exercise) certain bits for certain amounts of the time. So that's why, as you mentioned, we are providing some drum groups for Parkinson's disease.

And ParkinSonic, it's Parkinson's and song group, so it's known as the ParkinSonic group for Parkinson's disease. Not only for the gait or motor aspects; their speech is also very important, because usually their voice tone is more a monotone rather than having the intonation, and singing, and more like a therapeutic singing, would help to improve their intonation level as well as control the loudness. And also by singing, we can exercise the breath control by holding the notes as long as possible as we want.

So yeah, so that's why we are happy to provide the community service, not only for the Baltimore area, but then since it's provided by Zoom, you can connect from elsewhere. And I can give you the information.

Sophia Si:

So these are all in group sessions?

Kyurim Kang:

Yes.

Sophia Si:

Okay. Would you say that group sessions are a lot more effective? Say singing in a group or drumming in a group versus just doing that on your own?

Kyurim Kang:

That's a great question, because always in terms of the group, it depends on the patient's needs. But if they are required to focus on the exercise by themselves, individual sessions might be helpful. But then in terms of the group session, we feel more united, and we can add some additional aspects not only for the music, but also social cohesion. So I think that it would benefit more to share time with each other and to get synchronized with each other, so we can be happy more together.

Sophia Si:

Yeah, that makes a lot of sense. Also for these sessions, are they only particular to a certain neurological condition? So say ParkinSonics. Would that only be effective for Parkinson's disease, or do you think it could extend to other diseases as well, too?

Kyurim Kang:

Yeah, the project name and service name is just ParkinSonic, but it's not going to be only for Parkinson's disease. For example, singing would help us to be happy. I'm not sure if you are the shower singer, but then people can kick off their day from the singing, and that actually boosts our energy. So not only for specific patients like Parkinson's; we too also can have the benefits. And also this intervention, therapeutic singing, will not focus on the population, but then more like a symptom-wise. So whoever needs, not only for the emotional aspects, but whoever needs to use some intonation and loudness or breath control, respiratory system control. We do want to focus on rather than population, but then more like a symptom. So it's not limited to Parkinson's, but then whoever needs to improve and or want to enhance their voice control, and as well as the breathing control, the singing would be very helpful. And again, that's going to be very helpful for us as well, for the healthy population.

Sophia Si:

Right. So it's effective for people of all kinds, not just people suffering from certain conditions. People of all ages, as well.

Kyurim Kang:

Sure. And also for example, the kids. They always learn something from the songs, from babies to elderly. Singing is easy and accessible. I know some people don't want to sing out loud in front of other people, but then singing, in the form of therapy, is not only fun, but also helps facilitate speech production.

Sophia Si:

Right. Okay. And as you analyze these different therapies, how do you measure the effectiveness of them?

Kyurim Kang:

Yeah, that's a great point, because we all know that or we can expect the benefit of music therapy, but to know that, we actually need to assess the effectiveness of music therapy or any intervention types. So there are various ways to measure or study the effectiveness of specific therapy. But as a neurological therapist, we do use some standardized assessment for their specific goals. So we need to carefully review previous research papers to find out what standardized assessments have been used for which specific population, and specific domains, and specific cases. And also it is important to understand patients' music preference, their experiences, and their musicality, and so on. To understand their functional and effective level, the assessment will be very important to first plan the future therapy sessions, and second to examine the effectiveness of music therapy before and after the therapy sessions. And three, use standardized assessments because they will make it easier to communicate with other professionals and caregivers.

Kyurim Kang:

So for example, there are a lot of great and standardized assessments so that we can compare the scores to see if they increased or decreased, and we can communicate not only to the other health professionals like PT, OT, doctors, physicians, but also to the patients and their caregiver.

Kyurim Kang:

And in terms of the measurements, we do measure the behavior and functional performance to understand the effectiveness of music therapy. We could also assess and compare the neurophysiological responses before, during, and after music therapy. For example, measuring their electrical brain activities which is what I'm doing. And you can also measure functional activity and/or structural changes in the brain. You can also measure physiological responses, like changes in blood pressure or heart rate. So from the basic behavior and functional level to the neurophysiological level, we could assess and measure the response to the music therapy.

Kyurim Kang:

But sometimes it'll be important to have patients' self-report of their feeling and their sense of the music therapy session by requesting a quick questionnaire or interview. Because even though we are using well researched and standardized tests, the score differences may not correspond to the patient's feeling. So it's going to be also important to get the information from the patients directly

Sophia Si:

Wow, that's really amazing that Hopkins is doing all of this. For people who can't travel to this institute or don't have access to this therapy, is there any other way that they can still benefit from musical therapy?

Kyurim Kang:

We do provide the virtual music therapy session for Parkinson's disease, as I mentioned. And we also provide the support group for the neurodegenerative disease. So even though they cannot travel to our center, they can use Zoom. We also encourage caregivers to participate so that both caretakers and patients can attend the session. We are also creating resources, such as recordings of the musical pattern for specific movements, for patients to use at home.

Sophia Si:

Oh, okay. That's great. My last question is, for a high schooler who may want to become a neurological musical therapist in the future, what advice would you give them? What kind of training, classes?

Kyurim Kang:

Sure. We are providing sessions for individual patients, and each one is different, so we need to be very flexible. The training covers not just music, but also psychology, neurology, music theory, biology and social and behavioral science, neuroscience, and so on. You don't need to be a musician, performer, to be a music therapist, but definitely basic skills for the music would always be a benefit. Plus piano, guitar, and vocal proficiencies, and percussion are expected ... Those are most frequently used in therapy.

So to be a music therapist, I recommend to definitely get familiar with music, but then also find some resources, like researching music therapy programs. I can give you the information for the American Music Therapy Association, and they have a list of schools that offer the music therapy program. And also you should be comfortable interacting with others, particularly individuals who have disabilities or medical conditions. So I would encourage you to find some volunteer position to get the experiences for that, like at the local nursing home, or help with some special events for disabilities. That way, you can better assess if you are a good fit or not.

Sophia Si:

That's great. Thank you so much. It was so exciting talking to you. Good luck with all your research.

Kyurim Kang:

Thank you so much.

Sophia Si:

Since our conversation took place, Dr. Kang has informed me that the Center for Music and Medicine still offers both drum PD and ParkinSonics choral group, both online and in person. Those interested can check out the session schedule and contact information provided on the show page on both YouTube and wherever you listen to the podcast. However, guitar PD was part of a research project and has ended. Those interested in the effectiveness of ParkinSonics and guitar PD Can check out the two recent publications from the Center on the Science, Music, and Society podcast website.