The Role of Music Therapy in Stroke Rehabilitation

By: S.C. Ali

Founder/Author

Music is a universal form of art. Regardless of who you are or where you come from, it has the power to unite people. Music can affect people in various ways: mentally, socially, emotionally, physically, aesthetically, and even spiritually. Music therapy is an allied health profession that is designed to harness these musical effects to accomplish goals, which typically involve the well-being of the patient. It entails a multidisciplinary approach, for it spans psychology, biomusicology, music theory, acoustics, and others.

Have you ever felt certain emotions when listening to a particular song? Do you ever experience certain emotions in your daily life and think, “Such and such song explains my feelings perfectly.” This is no surprise, as there are many studies that indicate a correlation between music and the effect that it has on the brain. It includes a combination of the parts of our brain involved in hearing and auditory perception, and this discipline is part of a music therapist’s training. Because of the major leaps in neuroscience over the past 20 years, a new subfield of music therapy has developed. It is known as NMT, or neurologic music therapy. NMT was founded by the Center for Biomedical Research in Music (CBRM) at Colorado State University in the mid-1990s. According to the CBRM, it applies the goals of music therapy to patients who have suffered from neurological diseases such as: stroke, Parkinson’s disease, cerebral palsy, and traumatic brain injury.

A stroke, more formally known as a cerebrovascular accident (CVA), is defined as, “a blockage or hemorrhage of a blood vessel leading to the brain, causing inadequate oxygen supply.” There are two types of strokes: ischemic and hemorrhagic. In an ischemic stroke, a blood vessel in the brain is blocked, leading to impairment in the function of the surrounding brain tissue. A hemorrhagic stroke is when there is internal bleeding in the brain, which often results in a pool of blood. The treatments vary depending on the severity of the stroke. According to the CDC, strokes are the fifth leading cause of death in the United States. According to the American Heart Association, “one American dies from a stroke every 4 minutes.” Despite these alarming statistics, approximately 83.75% of Americans survive a stroke. However, the affliction oftentimes leaves patients motor or speech impaired.

Neurologic music therapy has been showing great promise for stroke rehabilitation patients. The type of debilitation that occurs in stroke patients depend on what part of the brain is affected. If certain parts (like Broca’s area and Wernicke’s area) are associated with language, then naturally the patient will present with a speech impediment if these areas are affected. The technical term for this is aphasia, and it has two forms. The first form is known as Broca’s/motor/expressive aphasia, which is when someone is able to comprehend but cannot produce language (speaking or writing). The second form is Wernicke’s/sensory/receptive aphasia, which is the opposite. In this case, someone is able to speak fluently, but has trouble understanding words, phrases, and sentences. Patients who have Broca’s aphasia interestingly respond well to melodic intonation therapy. In this technique, the music therapist will sing a song, and the patient is able to follow along. Eventually, the patient reaches the point where although they still can’t speak, they can actually sing along with the song. After this primary step, the music therapist aims to remove intonation in music so that the patient is able to speak once again. There have been various studies since the mid-1990s. The most recent study was from Stahl et al. in 2013 from MIT. They found that fifteen Broca’s aphasia patients responded well to the rhythms and language in music. Because each of the studies (which can be found here, here, and here) only look at small sample sizes, more experiments need to be conducted. Also, this technique hasn’t been proven for Wernicke’s aphasia, and thus either a similar study or a different music therapy technique needs to be conducted. However, these studies show encouraging results.

The other common impairment in stroke patients is motor difficulties. In this case, patients need to be retaught how to perform basic motor duties that typically involve the arms and legs. In 2014, Thaut et al. published in a scholarly journal an overview of the NMT techniques used in stroke rehabilitation. According to the article, early studies by Paltsev et al. and Rossignol et al., “show evidence for the complex physiological interactions between the auditory and the motor system.” In terms of applying this to music therapy, the paper notes that studies show that rhythmic cues from music can help patients with gait and stepping. It is important to note that this relationship helps to improve the auditory/motor relationship, but not necessarily be a substitute for other current motor rehabilitation methods. A second technique used to improve motor skills is known as Therapeutic Instrumental Playing (TIMP). This process involves the music therapist teaching the patient how to play particular musical instruments (primarily percussion and keyboard). According to Thaut et al., the studies have shown improvement in joint strength, arm function, and range of motion.

In conclusion, technology and advances in neuroscience have changed the way we look at music therapy. Historically, the benefits of music therapy were viewed from a social science perspective. However, the rise of neurologic music therapy has allowed us to look at music therapy from a more scientific perspective. This viewpoint inculcates an evidence-based approach and rigorous scientific experimentation. Although more studies need to be conducted, technology continues to evolve in the neurosciences. This will enable us to keep moving forward in this very dynamic field. Most importantly, because strokes affect so many people worldwide, rehabilitation involving music therapy has a wide variety of application. Even the patient’s loved ones can be soothed by the powerful effect of music, which may make the coping process easier.

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Should you try the Mediterranean Diet?

By: S.C. Ali

Founder/Author

Earlier this month, a new study was widely publicized in the news correlating the benefits of the Mediterranean diet with a potential longer lifespan. As the United States focuses its efforts more on combating obesity, many nutrition plans are being considered. The Mediterranean diet has gained widespread recognition since the 1990s, and there is substantial literature on its health benefits. Proponents of the diet claim that it incorporates some key nutrients that would be lacking in a vegetarian/vegan diet, while also avoiding an excessive red meat diet that may cause harm. In this article, we will look at the history and development of the Mediterranean diet, the actual definition of a “Mediterranean diet” and most importantly, the health benefits according to scientific literature.

According to Willet et al., the Mediterranean diet stems from around the 1960s, where poor rural indigenous people of Crete and other countries in the Mediterranean basin (such as other parts of Greece, Southern Italy and Spain) used to observe a certain dietary lifestyle. This piqued the curiosity of scientists because these peoples had, “some of the longest adult life expectancy at the time and the rates of coronary heart disease, certain cancers, and other diet-related chronic diseases were at its lowest.” (More details on the health benefits later).

This origination carries a few implications. First, because the Mediterranean diet stems from the less fortunate, the observation of the diet itself has the potential to be inexpensive compared to other diets. One of the most common complaints from people trying to observe diets is the sheer cost of eating healthy. However, based on the simplicity of the Mediterranean diet, it is relatively cost effective. It is also very important to note that the Mediterranean diet is actually not a “diet” in a traditional sense. Instead, it is a culmination of eating habits observed by the indigenous peoples mentioned above.

The general definition of the Mediterranean diet as noted in Trichopoulou et al. published in the New England Journal of Medicine is as follows. Observe how the dietary recommendations are consistent with the location/availability of food to the populations of the Mediterranean basin:

• High intake of vegetables, legumes, fruits, nuts, and cereals (historically these were mostly unrefined/non-processed)
• High intake of olive oil but low intake of saturated lipids
• Moderately high intake of fish
• Low to moderate intake of dairy products (mostly in the form of cheese and yogurt)
• Low intake of meat and poultry
• Regular, but moderate intake of alcohol, preferably red wine with meals

The pyramid form is the main image of this article and was created by Faig et. al.

According to Dr. Trichopoulou, there were two major causes of the surge of interest in 1990s. First, scientists were beginning to realize the potential harms of simple carbohydrates in decreasing the HDL, also known as good cholesterol, and increasing “metabolically undesirable glycemic load.” Because carbohydrates and lipids are the primary source of energy, scientists started looking at diets that were rich in “good” lipids, in this case, olive oil. Second, scientists began to implement a scoring system and correlate the Mediterranean diet with its multiple health benefits rather than strictly ecological benefits.

Scientists’ thirst for additional knowledge about the Mediterranean diet continues until today. There are many recent studies that have been published which correlate the Mediterranean diet to a positive health outcome. These studies tend to be epidemiological in nature. Here are the major health benefits coupled with the correlating studies:

• Observers of the Mediterranean diet tend to have a longer lifespan, reported by Trichopoulou et al.
• The incidence of coronary heart disease is lower as reported in Mente et al. There is some considerable overlap between the brief dietary suggestions in my previous article on heart disease, and the Mediterranean diet.
• Lower risk of cancer overall, reported in Couto et al.
  • Lower risk of breast cancer, reported in Trichopoulou et al.
  • Lower risk of colorectal cancer, reported in Bamia et al.
• Reduced risk of a stroke, as noted by Misirli et al.
• May reduce the incidence of Type 2 diabetes, noted in Rossi et al.

Finally, the most recent discovery, which I alluded to at the beginning, is a potential longer lifespan. This is based on a study by Crous-Bou et al. which stated that stricter adherence to the Mediterranean diet led to longer telomeres. Because telomere length is a biomarker for aging, it indicates a longer lifespan. Telomeres are structures at the end of chromosomes that protect the ends from deterioration or fusion with adjacent chromosomes.

In conclusion, the Mediterranean diet has a lot of positive health benefits to offer, and can lead to a healthier lifestyle by preventing some of the most common afflictions. It has the potential to be economical. However, this nutrition plan is only one of many. It is crucial that you consult your physician, health care professional, or a personal dietician before deciding to try the Mediterranean diet or not. Also, social considerations need to be taken into account, and should be discussed with your health care provider/dietician. Every individual is different and although these findings are promising, great care must be taken in implementation.