Searching for the Sense of Self in the Dementia-Afflicted Brain

We know music runs through many structures and areas of the brain and is very involved with memory processes. We remember hundreds if not thousands of tunes and melodies, can recall titles, lyrics, and artists, associate certain songs with emotions and events, and remember all this many decades after it is first learned. Clearly however memory works, music might be a great way in which we can come to understand it.

It all starts at the auditory nerve that processes sound and allows us to hear the music in the first place. From there, we are not so sure. The top theories out there say that because music affects emotions, it must be processed in the limbic system, an inner brain pathway that consists of the multiple areas shown below.

While the limbic area controls many aspects of function, it is largely involved with emotion. The amygdala in particular is known to control emotional behavior and motivation. This means it ultimately affects our emotional moods and actions that we do not really control, or autonomic responses, via communication with the thalamus and frontal lobe. Another part of the limbic system, the hippocampus, is involved with memory in regards to factual information, or declarative memory, and might be why certain music is thought to help students memorize vocabulary while studying for an exam.

Memories are deemed more valuable and seem to perpetuate longer when they are emotionally significant. It's easier to recall your happiest, angriest, and saddest moments versus those from emotionally uncharged circumstances. Songs which carry an emotional significance seem to trigger these memories, and this is especially important for those with dementia. When many of their most important and valuable memories seem permanently lost, music allows certain emotions, and the memories associated with them, to reappear. Concetta Tomaino, a renowned music therapist who has truly pioneered the field, wonders if in this way, music can be used to re-access the sense of self in a dementia patient who has essentially forgotten who they are. She even quotes world-renowned neuroscientist Oliver Sacks from his novel "Music and the Brain" which I have also happened read for the purpose of this project, that I feel perfectly sums up this idea that music can rekindle lost memories and even oneself: "[I]t is the inner life of music which can still make contact with their inner lives which can awaken the hidden, seemingly extinguished soul; and evoke a wholly personal response of memory, associations, feelings, images, a return of thought and sensibility, an answering identity."

Citations

Tomaino, C. (2009, May 20). Cognition ~ How Music Can Reach the Silenced Brain. Retrieved March 24, 2017, from http://www.pbs.org/wnet/musicinstinct/blog/cognition/how-music-can-reach-the-silenced-brain/?p=31

Name That Tune

One of the "games" the music therapists play with the participants at the daycare center for the elderly is called "name that tune." It is actually run by the music therapy intern who studied and earned a music degree from Berklee College of Music, and plays violin, viola, guitar, ukulele, and I'm sure every other instrument under the sun. Essentially, she plays on her violin a few bars of an old song that the residents might have loved in their youth, and has them try to puzzle out what it is. Once they do, she'll play more of each song so that they can sing along with the lyrics, which they often know!

It's a fantastic exercise on many levels. One, it triggers the memory. The participants recognize and identify songs that are likely many decades old and that they have not heard in a long time. They recall melodies and lyrics that they sang in their youth-- a fun and effective exercise to revive memories that sit deep within their minds. This long-term memory recall also has an emotional component, where songs from a past time in the residents' lives stir up feelings of happiness and nostalgia, or whatever other emotions they might have tied to a particular song. This is beneficial to overall well-being-- ensuring residents' happiness, and brightening their days at the center. Lastly, a key objective of playing "name that tune" is to engage the participants' focus. Many of the people at this center are often unaware of or inattentive to their surroundings, so a game that strengthens their focus and engages them so that they must pay attention is beneficial to their overall mental health and allows them to be more alert and function at a higher level throughout the day.

On Friday I have the opportunity to bring in my own violin and co-run this exercise with the music therapy intern; I am so excited to offer my own experience to the men and women at the center. I have to say, my "name that tune" repertoire doesn't really extend far beyond "Oh Suzanna," "La Vie En Rose," and "Happy Birthday." I guess it's time to add some Elvis, Sinatra, and Beatles music to the mix. Any forties, fifties, or sixties suggestions?

Stories of People and the Music that Impacted Them

Neurologic Music Therapy is known to be effective, allowing individuals to cope with and sometimes heal their mental or cognitive afflictions. Aside from these common cases of music at work in the human brain, there are also some seemingly miraculous and mind-blowing stories of music and its ability to rewire the brain.

Sam: A man in his sixties and recovering from a stroke that affected his left side, Sam experienced significant weakness that caused him to have a faltering gait where his left foot would drag behind him.Traditional physical therapy offered little improvement. Then Sam tried music therapy. The therapist found music that exactly matched the tempo of his stride, and after a short time, not only was Sam able to walk more normally and with confidence but to dance along the way, clicking his heels and sliding his feet. In his youth he danced at the gym, and so he applied those experiences to the present, focusing not on walking but on dancing to the rhythm. With more therapy sessions, Sam was soon able to lift his left foot off the floor, and though he was not consciously aware of it, had more control and was regaining sensation of his left side. Turn the music off though, and all progress was lost. In Sam's case, his internal rhythm, or movement of his legs, matched the external rhythm of the music to which he listened. His mechanisms for conscious movement were damaged, but through subconscious connections tied to music, he was able to move in ways previously impossible. Music therapy gave him the ability to move freely again.

Sally: Sally suffers from leukoencephalopathy, a degenerative disease that destroys the white matter of the brain. In the nursing home in which she lived, she spent her days pacing the halls and crying. In fact, her crying was the only vocalization she made; she was mute. One day, as a therapist was playing music for some other residents, Sally began to sing the full lyrics of the song, and dance along into her room. Sally's sister confirmed that Sally had loved music in her youth and would sing and play the piano for house guests, and she was blown away by her sister's transformation. The staff would sing with Sally everyday. Soon she began to regain her speech, she stopped endlessly wandering the halls, and no longer continued to cry. Music released her from her personal imprisonment in her brain.

Matt: A middle-aged man, Matt has suffered from severe Tourette Syndrome his entire life, his body wracked with uncontrollable involuntary movements, called tics, that interfered with his everyday life, and tortured him as a child, making him violent and reserved. Then he began playing the drums, and as he did so, his tics disappeared. As soon as he stops drumming, they appear again. Even so, playing the drums or simply drumming on whatever surfaces he has available, has alleviated his involuntary movements and allowed him to take control of his life again. Now he wants to help others, and has started a drumming workshop for people with Tourette's, helping them to manage a syndrome was previously thought to be uncontrollable.

Citations

Tomaino, C. (2009, May 20). Cognition ~ How Music Can Reach the Silenced Brain. Retrieved March 24, 2017, from http://www.pbs.org/wnet/musicinstinct/blog/cognition/how-music-can-reach-the-silenced-brain/?p=31

(2015, September 14). Retrieved March 24, 2017, from https://www.youtube.com/watch?v=tqrNEmuSCis

Music Picks

In preparation for my experiment in April, I have designed six surveys. Survey number one is the control, where the test will be taken in silence. Survey number two has the classical music treatment. The participants will listen to Mozart's well known Eine Kleine Nachtmusik, K 525 Allegro. Survey number three features pop music, represented by Bruno Mars' 24K Magic (the clean version of course). Number four is hip-hop/rap with the song Put On by Young Jeezy featuring Kanye West. Number five showcases rock music with Steppenwolf's Born to Be Wild, and finally survey six has electronic dance music (EDM) represented by Marshmello's Ritual featuring Wrabel.

All of these songs were chosen with the intent to best represent their respective genre of music.

Because different types of music stimulate the brain differently, it should be interesting to see how certain genres might impact immediate visual memory recall. Some music stimulates the motor cortex, causing us to dance, some stimulates the visual cortex, allowing us to conjure up images, and music with words trigger language centers in the frontal and temporal lobes. These multiple ways in which music affects us may ultimately affect our memory as well. More on that soon.

More on the Experiment

I would like to talk more about the experiment I plan to conduct before I begin in April.

The entire process will span roughly three weeks, possibly more, and will consist of six surveys. Each survey is structurally identical, but features a different genre of music. I ask the introductory questions: 1)What is your age, 2)If you are in school, what is your grade level, and 3)How do you identify. Then, a link included in the survey will send the participants to the memory game they will be playing, and they only play it once. Survey number one will be the control without music, however for surveys two through six, I will play a song from a certain genre of music throughout the room for the participants to listen to while they play the memory game. Finally, question four on the survey requests their score on the game. It is roughly a five minute process. Quick and easy!

The people participating in this experiment are the BASIS Phoenix AP psychology classes, as well as the BASIS Phoenix faculty and staff. I hope this experience will be both fun for them and yield interesting results for me. I guess we will see.

Experimenting with Music

I have planned to perform an experiment... on the students and staff of BASIS Phoenix. It will take place over several weeks starting in April and will consist of multiple trials that measure memory recall. I will be using an online memory game to test the participants while they listen to different genres of music, or no music at all.

At this point I have narrowed down the genres to classical, rap, hip-hop, electronic dance music (EDM), and hard rock, as well as the no music control. I am not sure what the outcome of the experiment will be, but I am hypothesizing the classical or no-music treatments will yield the highest memory scores because they are less distracting and allow for better focus.

I think in terms of strictly long-term memory, the outcome would be different. Music can be used to trigger declarative long-term memory, such as in the memorization of certain facts such as words or items after the span of a few minutes, hours, days, weeks, or even longer.

I might have to conduct another experiment.

This One Client

Each week at music therapy we work with a small group of men and women. We might see some faces on Wednesday and different faces on Friday, but generally the group remains the same. One particular participant, I'll call him Bernard, is younger than many of the others-- maybe late fifties, early sixties. While I do not know what he suffers from, it leaves him unable to communicate and move of his own free will.

I spoke with the music therapy student who began interning in October, and she told me how when she first met Bernard, he would often sleep through the hour-long therapy session and his movement would be minimal to none. Since then, and especially since I have seen him over the past three weeks, Bernard has improved. While still nonverbal, the start of each session puts a happy grin on his face. His feet begin tapping to the music, and his eyes follow the therapist as she guides the activities and leads the songs. I am not the only one who has noticed this improvement; the music therapist has caught on as well and has begun giving him extra time and attention while the therapy student takes over. Today she held a hand drum slightly above his knee, asking him to lift his leg to tap it. And he did-- multiple times even. Last week he was able to popcorn drum (see previous post They Don't Know It's Therapy) at his own pace where before he would not even move his arms at all. Bernard's progress with the help of music therapy is truly amazing and very rewarding for everyone involved. Music therapy works.