{"id":14997,"date":"2018-03-16T08:32:03","date_gmt":"2018-03-16T14:32:03","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=14997"},"modified":"2023-03-06T10:03:11","modified_gmt":"2023-03-06T17:03:11","slug":"neuro-music-therapy-helps-shine-light-in-dark-spaces-of-the-mind","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/neuro-music-therapy-helps-shine-light-in-dark-spaces-of-the-mind\/","title":{"rendered":"Neurologic music therapy helps shine light in dark spaces of the mind"},"content":{"rendered":"
<\/div>
\"Randy
Randy Schiell with wife Janelle in their Denver home. The couple participated in a study examining the effectiveness of neurologic music therapy in slowing the progression of dementia \u0096 caused in his case by Parkinson’\u0092s disease.<\/figcaption><\/figure>\n

One day last summer, Janelle Schiell took her husband Randy to UCHealth University of Colorado Hospital<\/a>, where he spent the next 10 days. Following the hospital stint, Randy entered a facility for physical and occupational rehabilitation of symptoms related to his Parkinson\u2019s disease.<\/p>\n

The problems that led to his institutional stint, however, were more than physical. Behavioral issues \u2013 anger, moodiness, suspicion \u2013 had \u201ccome to a head,\u201d Janelle recalled. She and Randy, now 65, have been married 44 years, but he\u2019d accused her of having an affair and told her she needed to leave their home.<\/p>\n

The words stung her, but she worked to understand what brought out the words she knew he didn\u2019t mean. Overmedication and dehydration were possibilities. Another was dementia, which is common among Parkinson\u2019s disease patients and shows up, on average, about 10 years after the initial diagnosis<\/a>.<\/p>\n

Randy Schiell received his diagnosis of Parkinson\u2019s disease 10 years ago. He had built a successful career in financial management and held a bachelor\u2019s degree in sociology from the University of Colorado Boulder and an MBA from Colorado State University. But the disease gradually weakened him, and he had to give up working when dangers like falling asleep while driving cropped up. He at times became overwhelmed by information and struggled with retrieving words.<\/p>\n

Sitting with Janelle in their Denver home on a recent morning, Randy Schiell is quiet, speaks with some difficulty, and dozes off briefly from time to time. But when he answers questions and expresses himself, he is cogent and articulate. He gives a succinct statement as he listens to talk of the time in the rehabilitation facility.<\/p>\n

\u201cWe worked hard to get out of there,\u201d he says softly.<\/p>\n

\u201cIt\u2019s better to be home,\u201d Janelle nods.<\/p>\n

Music as medicine<\/strong><\/h3>\n

A glance at their surroundings confirms that. A long hallway that runs from the front door, past the kitchen to a large, open living area is lined with photos of them together and with their son and daughter and extended family. Janelle\u2019s paintings brighten the living room along with sunlight that pours in from windows facing the midtown street. Randy has his exercise equipment close by and when he\u2019s up to it, he can take walks along city streets and in parks filled with life.<\/p>\n

\"A
UCHealth behavioral neurologist Samantha Holden led the study. She hopes that neurologic music therapy can help to keep dementia patients out of nursing homes.<\/figcaption><\/figure>\n

Home is the best choice for patients living with dementia, said Samantha Holden, MD<\/a>, a behavioral neurologist<\/a> with the University of Colorado School of Medicine, but it\u2019s not easy to make that happen. Holden sees that firsthand in treating dementia patients in her clinic at University of Colorado Hospital.<\/p>\n

\u201cThe amount of money we spend on institutional care is exorbitant, and it\u2019s often not good care,\u201d Holden said. \u201cI hear every day in my clinic from caregivers who want to keep their loved ones at home, but as the dementia advances, behaviors become more and more stressful, not only to patients but also to their loved ones.\u201d<\/p>\n

Pills don\u2019t provide an answer, Holden added. Medications can address anger, fear and depression at least temporarily, but they also can make patients sleepy and docile \u2013 depriving them of a measure of their humanity.<\/p>\n

\u201cThat\u2019s not necessarily what we want for patients who are also medically fragile,\u201d Holden said.<\/p>\n

Lacking a magic pill to reduce the burden on caregivers while helping patients, Holden turned to music. She launched a small study, recently completed, that used structured sessions at Rehabilitative Rhythms, an Aurora-based facility staffed by music therapists who are certified to treat neurologic conditions with evidence-based techniques. ProjectSpark<\/a>, which supports education and research for Parkinson\u2019s disease, funded the study. Another goal was to give patients and caregivers the tools and skills to continue the neurologic music therapy at home.<\/p>\n

\u201cI was looking for something that is safe, non-invasive and fun that might jog the brain in a creative way,\u201d she said.<\/p>\n

The right notes<\/strong><\/h3>\n

The Schiells joined the study after hearing a presentation by Rebekah Stewart, MA, MT-BC, a neurologic music therapist at Rehabilitative Rhythms, during a meeting of their Parkinson\u2019s disease support group at a church in southeast Denver. Stewart assured the group that they didn\u2019t have to play an instrument or have special music ability to be part of the study. The idea was to use music as an entr\u00e9e to areas of the brain where memories, emotions and imagery reside \u2013 places shrouded by the advance of brain cell death and dementia.<\/p>\n

Contrary to popular perception, there is no \u201cmusic center\u201d in the brain, Stewart said. \u201cMusic is processed all over the brain,\u201d she said. \u201cThat\u2019s what makes it a unique tool in treating neurologic injury.\u201d Neurologic music therapy is well-established, for example, as a method for helping to improve gait and balance in stroke patients<\/a> and those with Parkinson\u2019s disease and other movement disorders<\/a>. In another class, Stewart leads a class of Parkinson\u2019s disease patients through singing exercises designed to strengthen their voices, which the condition often damages.<\/p>\n

Music\u2019s connective range includes regions of the brain that store both short- and long-term memories. Through a biologic process known as encoding, the brain essentially imprints perceptions, including sight, sound, smell and taste. The most powerful of these fire neurons, making them more vivid and intense and thus more likely to be recalled when they recede from immediacy to memory. It is this process that explains why an individual\u2019s brain sorts through the countless points of perception in a lifetime and retrieves a small number of them again and again. Music is a frequent spark that brings an individual\u2019s memories vividly to life.<\/p>\n

Dementia doesn\u2019t ravage the brain uniformly, Stewart said. \u201cCertain areas decline more rapidly than others,\u201d she said. \u201cSome areas that are preserved may be involved in music and memory and recall, and information tied to music may include experiences and imagery.\u201d<\/p>\n

\"A
Percussion instruments played a key role in the study. Patients and caregivers sang songs with special meaning to ignite memories while keeping time and completing words and phrases from the tunes.<\/figcaption><\/figure>\n

As Holden put it, \u201cThere is a tie between memory and emotion that is stronger than pure memory alone.\u201d<\/p>\n

Lighting the darkness<\/strong><\/h3>\n

The six-week program she designed for the study included exercises designed both to tap into memory and to strengthen cognition. Patients and caregivers were asked to pick songs with special personal meanings. During sing-alongs, Stewart and her fellow therapists encouraged patients to complete phrases in the familiar songs. In exercises with percussion instruments, such as rain sticks, patients accompanied the songs to completion and improvised as the therapist played guitar or piano. Patients also worked with tuned instruments, listening to a short series of notes and deciding which should come next. In another exercise, they used color-coded tone bars to duplicate chords played by the therapist. Other exercises focused on mood and memory with theme-oriented song choices that prodded patients and caregivers to explore and describe their feelings.<\/p>\n

\u201cIt\u2019s an hour of tasks focused on specific areas of skills, using music as the medium,\u201d Stewart said. Just as importantly, the sessions helped patients to engage with their caregivers and others in the world outside themselves, she said.<\/p>\n

\u201cThis is a patient population with a degenerative disease,\u201d she said. \u201cThey won\u2019t interact as others do. We want to treat them as we would other people and interact with them at a human level. [Dr. Holden\u2019s] study was about patient and caregiver empowerment.\u201d<\/p>\n

The exercises \u201callowed us to connect,\u201d said Janelle Schiell. Stewart played songs \u201cthat sparked something in us,\u201d she said \u2013 tunes that summoned memories of dancing and evocations of bonding before and after their marriage in 1974 at St. Thomas More Catholic Church in what is now Centennial.<\/p>\n

For Randy the memories also extended into his childhood, with songs from a deep-rooted folk tradition expressed by the 19th<\/sup> century popular composer Stephen Foster. The son of an enlisted Air Force man, Randy was born in the medical center on the old Fitzsimons Army Base whose grounds are now home to the University of Colorado Anschutz Medical Campus. Among the two dozen or so places the family lived was Moody Air Force Base in Valdosta, Georgia, not far from the Stephen Foster Memorial in White Springs, Florida. With money tight, he and his family sometimes filled the car with gas and made a day of a drive to the memorial, stopping at the welcome center for a glass of orange juice, he recalled.<\/p>\n

Years later, he and Janelle visited his childhood home in Valdosta, where they found the house he lived in still standing, surrounded as before with the chinaberry trees whose fruit provided ammunition for friendly kid fights. They walked to the church he attended, where he remarked how much smaller it seemed compared to its size in his youthful mind\u2019s eye.<\/p>\n

These memories explain why Stewart played Foster tunes like \u201cCamptown Races\u201d and \u201cOh, Susannah,\u201d during the music therapy sessions. For Randy, their sounds shone light into darkening spaces of his mind.<\/p>\n

Stephen Foster notwithstanding, when asked to name his \u201cfavorite band of all time,\u201d he quickly responded with Led Zeppelin while giving Lynyrd Skynyrd a mention.<\/p>\n

\u201cThat\u2019s the reason he wears hearing aids,\u201d Janelle put in, but added he also likes to listen to \u201cold country,\u201d a taste she doesn\u2019t share. That spurs Randy to comment that the sounds of country-and-western pioneers Buck Owens and the Buckaroos produce particularly pleasant echoes from his childhood.<\/p>\n

\u201cThat music reminds me of my mother,\u201d he said.<\/p>\n

He and Janelle don\u2019t use the music therapy techniques they learned now, but CDs fill two vertical storage cases, and son Chris and his girlfriend, Margery Tran, downloaded all the music to his computer last Christmas.<\/p>\n

\u201cI like the energy that I get listening to music,\u201d he said. \u201cThere are certain songs that provide me with a positive outlook. They get me out of the mood when I\u2019m feeling low.\u201d<\/p>\n

A way home?<\/strong><\/h3>\n

Holden noted that the American Neuropsychiatric Association recently accepted an abstract of her study, but she readily acknowledges that neurologic music therapy is not a panacea for patients with dementia and the caregivers straining to care for them. Nearly half those enrolled in her study didn\u2019t finish the six-week protocol. Those who did achieved some temporary improvement in their quality of life and caregivers generally said they felt their burden lightened. But the effects were not sustained, nor would one expect they would be in patients with a progressive disease.<\/p>\n

\"A
UCHealth’s Dr. Samantha Holden designed a six-week music therapy program to tap into memory and strengthen cognition. These are some of the instruments used in the program.<\/figcaption><\/figure>\n

One take-away, Holden said, is the chances of improvement decrease for patients with moderate to severe dementia \u2013 whom the study targeted.<\/p>\n

\u201cThose who withdrew from the study generally had a lower quality of life to start, with more behavioral symptoms,\u201d she said. \u201cWe were getting to them too late, when caregivers were already stressed and overwhelmed.\u201d Starting the therapy earlier, when dementia symptoms are relatively mild, might yield greater success, Holden said.<\/p>\n

As Stewart pointed out, it is difficult to measure success in treatments for dementia, about which so much remains a mystery. But intangible improvements shouldn\u2019t be ignored, she added. Giving a weary caregiver inspiration to pull out some old records and gain renewed sustenance from forgotten sounds and encouraging them to make music a part of daily life for both themselves and their loved ones can count for a lot, she said.<\/p>\n

It\u2019s easy to see the strain of caregiving as Janelle helps Randy struggle up from his chair, grasp the handlebars of his walker and move with difficulty to his bedroom to rest. Watching them, one sees that her recent retirement as a paralegal was necessary to take on this full-time job, helping her husband through a difficult journey.<\/p>\n

But for now they will travel it along familiar ground, not the sterile corridors of a nursing home. And at home there will be comforts, found in the music, the paintings and the photos of a rich past that look down on them as Randy pushes the walker down the hall with Janelle keeping a watchful eye.<\/p>\n","protected":false},"excerpt":{"rendered":"

One day last summer, Janelle Schiell took her husband Randy to UCHealth University of Colorado Hospital, where he spent the next 10 days. Following the hospital stint, Randy entered a facility for physical and occupational rehabilitation of symptoms related to his Parkinson\u2019s disease. The problems that led to his institutional stint, however, were more than […]<\/p>\n","protected":false},"author":2143,"featured_media":15002,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[113,184,750,1497],"class_list":["post-14997","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-behavioral-health","tag-neurology","tag-parkinsons-disease","tag-uchealth-university-of-colorado-hospital"],"acf":[],"yoast_head":"\nNeurologic music therapy helps shine light in dark spaces of the mind - 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