Medical Treatments
11:00 am
Fri December 16, 2011

Treating Stress, Speech Disorders With Music

Transcript

IRA FLATOW, HOST:

This is SCIENCE FRIDAY. I'm Ira Flatow. You know that nice feeling you get when you listen to your favorite tune? What about music that can actually be medical therapy? It does exist. It's prescribed for illnesses from speech disorders to autism, Alzheimer's, even cancer.

Take the case of Congresswoman Gabrielle Giffords. After she was shot in the head earlier this year, one way she learned to talk again was by singing her favorite songs, like this Cyndi Lauper tune.

(SOUNDBITE OF ABC BROADCAST )

REPRESENTATIVE GABRIELLE GIFFORDS: (Singing) Girls, we want to have fun. Oh, girls just want to have fun.

FLATOW: That was from an ABC special on her recovery. But why is music therapeutic? What effect does it have on the brain if it's used as a treatment for many different conditions? That's what we'll be talking about this hour and listening to because a little bit later in the hour, a certified music therapist is here in our studio to perform live on the show and give you an idea of what music therapy sounds like.

And if you're interested in music therapy, maybe you've tried it, maybe you use it, maybe you're a practitioner, give us a call. Our number is 1-800-989-8255, 1-800-989-TALK. You can also tweet us @scifri, @-S-C-I-F-R-I, or join a discussion on sciencefriday.com.

Let me introduce my guests. Oliver Sacks is a physician and professor of neurology and psychiatry at Columbia University Medical Center here in New York. His latest book is "The Mind's Eye," and he is back with us in our New York studios. Good to have you back, Oliver.

DR. OLIVER SACKS: Good to be back.

FLATOW: Thank you for being with us. Connie Tomaino is the executive director and co-founder of the Institute for Music and Neurological Function at the Beth Abraham Family of Health Services in the Bronx, New York. She's also here in our studios. Welcome, Dr. Tomaino.

CONCETTA TOMAINO: Pleasure to be here.

FLATOW: And Joke Bradt is an associate professor in the Creative Arts Therapies Department at Drexel University in Philadelphia; she joins us from the studios of WRTI. Welcome to the show, Dr. Bradt.

DR. JOKE BRADT: Thank you, and thanks for having me.

FLATOW: And we're going to be talking with Connie - what exactly, how do you define music therapy, Dr. Tomaino?

TOMAINO: Well, music therapy is the use of music and the components of music to affect function, either cognitive, psychological, physical, most psychosocial and behavioral function, through interaction with a professional music therapist. Many times people assume something to be music therapy, but it really isn't if it isn't provided by a music therapist.

FLATOW: And that's a good point, Dr. Bradt, is it not? It has to be somebody who knows what they're doing, a trained musical therapist.

BRADT: Absolutely, and music therapists are actually trained at different levels. They can be trained at a Bachelor's level, Master's or even Ph.D. level. But as Dr. Tomaino just pointed out, it's very important that music is provided by a trained music therapist because music truly plays a primary role in the therapeutic process, to strengthen the client's abilities as well as to address their needs.

So it's not something peripheral in the session. Sometimes I think people have the misconception that just listening to music, listening to a CD is music therapy. While that certainly can be therapeutic, in music therapy many forms of music interventions are used, such as improvising music, singing, songwriting as well as listening to music.

But typically we use multiple musical experiences within a session, and we build up different experiences based on what the client is reporting. The discussions that we have following a music experience may lead us then to a very different type of music making.

FLATOW: Dr. Sacks, you and Dr. Tomaino have worked together for many years. A lot of your patients had trouble walking or moving - Parkinson's patients, for example. Give us an idea of how music helped some of those patients.

SACKS: Well, Connie and I have worked together since 1979, but before that, when I went to our hospital in 1966, there was a large population of people with Parkinson's and great difficulty moving and specifically initiating movement. I wrote about these patients later in "Awakenings."

They couldn't initiate, but they could respond, and they responded above all to music. At first, when I saw these people who seemed speechless and motionless, zombies, I didn't know if there was anything going on. But when I was told that they could sing and dance, I said you're kidding me. But then I saw it for myself. And music is vital for people with Parkinson's.

FLATOW: And any other neurological diseases?

SACKS: And many others, in particular people who have lost expressive language, who have become aphasic, may still be able to sing and even to retain some of the words of a song. You know, whenever I see patients who are aphasic, the first thing I do, whether it's their birthday or not, is to ask them to sing "Happy Birthday." And sometimes they are themselves amazed that language is still there, although maybe embedded in song.

And - but songs can be a remarkable bridge from music to the restoration of language, and when language is restored, it may be on the other side of the brain, which is very remarkable.

FLATOW: Dr. Tomaino, that sounds example like what happened with Congresswoman Giffords, right?

TOMAINO: Right. You know, what Dr. Sacks is saying about how well people who have had strokes, who have aphasia, can sing words to songs, even though they can't speak it, what neuroscientists are telling us is that the shared mechanisms, neural networks, that they're shared between speaking words and singing the words.

What happens when somebody sings a song is the lyrics of that song are so well-preserved that it's easier for them to access those words through song rather than to speak them freely. And so we use the song as a preliminary way to stimulate word retrieval.

And what some of the neuroscientists are showing us, that there's actually compensatory mechanisms on the right side of the brain that start to build up as somebody starts to recover the use of these words through singing.

FLATOW: Are they recovering those words, the music, from a different part of their brain than they would if they were speaking it?

TOMAINO: It's a shared process. So they're singing the words utilizing networks responsible for speech and singing. The areas that have been damaged are the word retrieval mechanisms on the left (unintelligible) area, but singing the word is different from speaking the word. And over time, the singing the word stimulates the recovery of speaking the word but using a different part of the brain to do that, which is amazing.

FLATOW: And you've noticed this, Dr. Sacks?

SACKS: Yes, this is an amazing business. It's quite intensive, and it requires close relationship between a - the patient and the therapist. And it's quite a big investment but a fantastic one because it may prevent one being speechless for the rest of one's life.

There may be similar shared mechanisms which allow people who stutter to sing fluently.

FLATOW: Dr. Brandt, you use it for chronic pain, do you not?

BRADT: That's right.

FLATOW: Tell us about that.

BRADT: Patients who live with chronic pain often view their body as the enemy, and the body becomes something that needs to be fixed, something that needs to be avoided. And when I was working with patients with chronic pain initially, I used a lot of instrumental improvisation.

But very quickly I discovered that when I used voice with them that it was - gave them an opportunity to reconnect with their bodies in a very new and different way, and they were able to build up a positive relationship with their body.

For example, rather than trying to avoid the body, through singing one can truly feel the vibrations of your voice through your body, and by using different pitches you can use different parts of your body. And people would be surprised how it feels like to feel their body again.

But more importantly, as they were, or as they are reconnecting with their body, they also are now suddenly being put in a position to reconnect with their emotions. As you - as the listeners may have experienced, when we try to hold back on emotions, let's say at a funeral or when your boss yells at you, very often we feel it in our throat. We get a very tense throat. We may even have a sore throat afterwards.

And it's because we regulate much of our emotions by holding in our breath or by holding down, literally, our voice, and when you engage in singing, suddenly that gateway is opened, and through singing and deep breathing these patients who really have been trying to stay away from their deep inner feelings are suddenly reconnected with those.

And so through singing we are able to work through the trauma of living with chronic pain, as well as trying to learn to manage and cope physically with the pain as well as actually we have a lot of fun singing together, harmonizing together. So it gives them a lot of energy and fun and helps them a bit with their fatigue and their often hopeless mood.

FLATOW: It almost sounds like they're taking - they're on drugs.

BRADT: Absolutely, and that's the beauty of vocal music therapy is that I'll give patients very specific exercises to take home, and they can just do it. And some patients initially will only do it in the car or in the shower because they don't want their partner to hear them, but very quickly they get comfortable just using singing throughout their day to help them deal with their emotions, as well as with the physical pain.

FLATOW: Does it take the place of medication? You know, can you get the same, you know, effects in the brain without giving them drugs that the singing does?

BRADT: I haven't gone that far yet, but definitely what we do know, chronic pain is a huge issue because medical - sorry, medicine is just not enough and often does not bring enough relief to these patients. And so music, together with medicine, can help them manage their pain better.

And some patients will report that they were able to start reducing their pharmacological intake.

FLATOW: Connie Tomaino, you...

TOMAINO: There's actually some scientific evidence that the experience of pain is gated when somebody is listening to music. There's also been some studies about the elevation of certain neurotransmitters when somebody hears music, just passively listens to music, that is emotionally important to them or stirring to them.

So those particular songs actually increase serotonin and other types of neurotransmitters that work as an analgesic. So we have a natural mechanism within our body to actually gate pain if we listen to music that's pleasurable.

FLATOW: We're going to take a break and come back and talk lots more about music therapy, and actually we have a musician sitting right here next to me. We're going to talk - give a little bit of a demonstration about what kind of musical therapy is in effect and how to do it. Our number, 1-800-989-8255. Sitting here with Oliver Sacks, Connie Tomaino, Joke Bradt, and Andrew Rossetti is going to be joining us right after the break. So stay with us. We'll be right back.

(SOUNDBITE OF MUSIC)

FLATOW: This is SCIENCE FRIDAY. I'm Ira Flatow. We're talking this hour about music therapy and the various ways music can help patients. Talking with my guests Oliver Sacks, Connie Tomaino, Joke Bradt, and I'd like to bring on another guest who can tell us about how some hospital departments are using music therapy and give us a sample of what some stress-relief music therapy sounds like.

Andrew Rossetti is a musical therapist in radiation oncology at the Louis Armstrong Center for Music and Medicine at Beth Israel Medical Center here in New York. Welcome to SCIENCE FRIDAY.

ANDREW ROSSETTI: Thank you, pleasure to be, Ira.

FLATOW: They created a whole division for musical therapy at the hospital?

ROSSETTI: There is indeed a department, a music therapy department, that has been in place for 19 years.

FLATOW: It's that well-accepted - I mean, people don't know about it, but you certainly have known about it for many years then?

ROSSETTI: Sure, that's true.

FLATOW: Give us an idea, you're sitting here with your guitar in hand at our microphone. Give us a sample of what you might play for a radiation patient, for example, to relax. What kind of music would that be?

ROSSETTI: OK, well, this is a little snippet of an intervention that I've been using in the music therapy program in radiation oncology at Beth Israel. And this is directed at patients that are coming in for radiation therapy on their first day, and they're receiving something called simulation, which is not radiation therapy, but it has been reported to be one of the most stressing moments for patients in their entire trajectory of treatment.

And so we've been targeting state anxiety in this, and this is a protocolized intervention that usually takes about 20 minutes. I know we're not going to have quite that long.

FLATOW: Right.

ROSSETTI: So it is an induction to altered state. I use suggestion. You're not going to be hearing all of that, just a little snippet of it. And at the end of it, I would use guided imagery, and during that time I'd be teaching patients different techniques that they can use during simulation to feel more comfortable, to be less anxious.

FLATOW: OK.

(SOUNDBITE OF MUSIC)

ROSSETTI: Focus on the music. Focus on the sound. Perhaps let's start off with a deep breath. I see you closing your eyes. If you feel uncomfortable at any time, you can open them. Allow yourself to focus now on the physical sensations of breathing, breathing in, breathing out, noticing how, as you breathe in, air enters your lungs, expanding them, the physical sensations of breathing out.

Focus now on the chair you're sitting on, on its surface, and allow yourself to settle into that surface.

FLATOW: I'm so relaxed.

(SOUNDBITE OF LAUGHTER)

FLATOW: I have the rest of a radio program to do.

(SOUNDBITE OF LAUGHTER)

FLATOW: That was - and that's very effective.

ROSSETTI: Thank you.

FLATOW: Yeah, and how often do you do this with the patients? Every time they come in for...

ROSSETTI: No, well, this particular - this is part of an intervention that lasts about a half an hour in total. And simulation is a - usually just a one-time experience.

FLATOW: And you also play this in the ICU unit, don't you? You play something - you play with the sounds that are going in the ICU unit.

ROSSETTI: That's correct. This is something called environmental music therapy, and it's a process that we're using to try and modulate the actual environment in the hospital, which is something that many patients feel to be hostile. And those feelings are something that actually, based on research that's being done now that's starting to come in, that feelings of being in a hostile environment do not actually lead to good medical outcomes.

So what we're trying to do is modulate the environment, have people feel more safe and comfortable, and the way we do that in fragile environments like an ICU or just waiting rooms where, unfortunately, people may have a long wait before they get treated, these are Petri dishes for anxiety. So this is something we try and address with music.

FLATOW: Let's see if we can give our listeners an idea of how it would sound and the kind of music you would use to try to tone down the scary, I guess would be the word, the anxious producing - let's listen to the sound of the ICU unit and how you might mask that or modulate that with your music.

(SOUNDBITE OF INTENSIVE CARE UNIT)

(SOUNDBITE OF MUSIC)

FLATOW: So you're changing your music as we hear those beeps and chimes going off, to match them.

ROSSETTI: Trying to interact with what I'm hearing, not - one of the things that I interact with is the actual ambient sounds, but the other thing is that this intervention is interactive with patients. So ideally I'm trying to read cues and clues from the patients also.

But yeah, I'm trying to structure these annoying monitor sounds that we were hearing in the background.

FLATOW: And we talked before about your first - the first music that you played for the patient. How do you decide when that patient needs that music, which patient is a candidate to have that?

ROSSETTI: OK. Sure, well, all of my patients are by referral from the radiation oncologist that I work with on the unit. And they're assessed first off for state anxiety.

FLATOW: And then decide from that. 1-800-989-8255 is our number. We're talking with Oliver Sacks, Connie Tomaino, Joke Bradt and Andrew Rossetti, talking about music therapy. Oliver, you've been doing this for years. You must be very familiar with these kinds of treatments and these patients in a different modality.

SACKS: I've had less experience with pain and anxiety as the problem as various hard neurological ones like Parkinson's and aphasia and dementia. Dementia is - can be a huge challenge, and in every chronic hospital and nursing home there are - will be dozens of people who may be confused, disoriented, withdrawn, or very noisy.

And when a music therapist comes in - I've seen this often with Connie, almost within seconds eyes will fasten on her, and people will cock their heads to listen, and perhaps some will start to sing along, and that is very, very amazing and very important.

Partly because musical skills and musical sensibility outlast ordinary memory and intelligence, and almost indelible and can be reached even in people who are very demented. And when they listen to music which they know and love, the circumstances and the memories and the feeling which went with that music come back to them and anchor them and animate them. And that's very remarkable.

I'm sure a lot of these patients also have anxiety, and some have pain and probably several things are addressed at once.

FLATOW: Connie, is there any standardization to what you do? I mean, you do it so well, but how many places around the country know how to do with with the skills that you have?

TOMAINO: Sure. Ira, that's the challenge. The field of music therapy, like the field of medicine, is very broad, with many treatments and applications depending on the patient, the need, the environment. Some like to work psychotherapeutically with somebody or work as music and medicine more prescriptively with a musical treatment that would target something like speech recovery or memory enhancement. What's happening around the country is that advanced trainings in specific modalities using music therapy in the NIC unit, for example, or neurologic music therapy or specific applications using a certain model of music therapy for a specific population and specific reasons.

And if people want to check, the American Music Therapy Association has a lot of different fields or fields of music therapy as applications in music therapy that people can learn more about how music therapy is applied across different populations.

FLATOW: Can you get a degree in music therapy?

TOMAINO: Oh, you do.

FLATOW: You can.

TOMAINO: Yes, both undergraduate and graduate level. Music therapy is a board-certified profession, where somebody after they have mastered their academic training do 1,200 hours of clinical supervision and then sit for a board exam. And then in several states, like New York state, it is a licensed profession as well.

FLATOW: We were talking about right at the beginning that - and you defined musical therapy and Joke Bradt said the same thing that you have to be a trained musical therapist...

TOMAINO: Music therapist.

FLATOW: ...excuse me - music therapist.

TOMAINO: We're very musical.

(SOUNDBITE OF LAUGHTER)

TOMAINO: But it's music.

FLATOW: So when you say music therapist, you're not - we're not talking about like Andrew Rossetti playing the guitar here. They - you have to know how to play the guitar. You have to know how to use what he does or...

TOMAINO: You have to know to read the patient...

FLATOW: Yes.

TOMAINO: ...so you can manipulate music in real time. That's where music therapy differs from prescribed music listening programs or a musician coming in and playing by bedside because they want to do something nice for the patient.

FLATOW: Right.

TOMAINO: There's a lot of excellent musicians who do bedside visits, or programs like that. But music therapists are trained either psychotherapeutically or in music and medicine to use music and the components of music for a very prescriptive reason. And that's why you'll hear music therapists speak differently about their work because of the populations they work with.

FLATOW: Dr. Bradt, you've looked at a lot of clinical trials of music therapy...

BRADT: Mm-hmm.

FLATOW: ...gold standard evidence for whether the music therapy works. Does that exist?

BRADT: That's right.

FLATOW: It - what have you found?

BRADT: Well, we - together with a colleague of mine, Dr. Dileo of Temple University, we indeed saw the need to look at what evidence is out there and how can we summarize this so that people have a better idea of what the true impact of music therapy is. And we decided to do Cochrane systematic reviews, which is indeed considered the gold standard in evidence-based practice, and basically, we looked or identified randomized controlled trials in medical music therapy, so medical applications of music therapy.

And we did that with a variety of patient groups. We did a Cochrane review with cancer patients. We did one with cardiac patients, mechanically ventilated patients, people with acquired brain injury and people in end-of-life care. And we found many different things, but I think overall and what Andrew just talked about is that music interventions help patients, medical patients reduce their anxiety. We found a significant impact of music interventions on anxiety in cancer patients and people with heart disease, especially those who had just suffered a heart attack and people on mechanical ventilation.

In addition to that, we found that music therapy improves quality of life in cancer patients and patients at end of life. Now, these findings were based on just a few trials, but they greatly agreed with each other, so that was an important finding. And then, also important was that we found that music is able to reduce heart rate, respiratory rate and blood pressure, and these were very important findings for patients such - the heart disease patients or patients on mechanical ventilation because as you can imagine a heart disease patient who is hospitalized experience great anxiety. And this increased anxiety then leads to increase heart rate and so, of course, puts them at a greater risk for a heart attack again. This thing with mechanic...

FLATOW: Let me just...

BRADT: Mm-hmm.

FLATOW: I just have to remind everybody that I'm Ira Flatow, and this is SCIENCE FRIDAY from NPR. I'm sorry. I didn't mean to interrupt you there.

BRADT: No problem. And also with mechanically ventilated patients, these patients experience great discomfort because of the frequent suctioning, the inability to talk, with that comes huge stress and discomfort. And if music can help reduce their anxiety and help reduce heart rate and respiratory rate, reduce their blood pressure, of course, that can only have important health benefits.

FLATOW: Let me get - let me go to...

BRADT: And then...

FLATOW: Before we go to the break, let me go - get a phone call in here if I can. Let me go to Susan(ph)...

BRADT: Sure.

FLATOW: ...in Tempe. Hi, Susan.

SUSAN: Hi. How are you?

FLATOW: Hi there.

SUSAN: Thanks for bringing attention to this subject. I have a comment and a question. I am - first of all, I am a mother of four boys, small boys. Two of them have autism, and one of those is nonverbal. I don't think anybody understands how important music therapy is to the autism community because of the effect that it has on these nonverbal kids. When I - there is nobody more skeptical of music therapy than me. I'm an airline pilot for a living, so if it doesn't have to do with science, I'm generally not getting it.

My son, my 6-six-year-old son, basically did not speak. He would string maybe two words together. That was his idea of a sentence. I walked into a pet store one day, and he sang from beginning to end the song "Slippery Fish." It had seven stanzas. And I - my jaw hit the floor, and I went back to his access liaison with the state, and I said he doesn't speak, yet he sang this song. She goes he needs music therapy. And I looked at her, and I go I am really busy with these four kids. I don't need something that isn't going to be effective. She said it will, trust me.

We have had eight different music therapists now. And the reason is, is because of the massive cuts that the music therapists have taken here in the state of Arizona - and I'm talking 40 to 60 percent cuts. The last one who had to quit, she said I make more money at Nordstrom, and the reality is I have to provide for my family. But my child, my nonverbal child, the one that spoke like two words together with his sentence, he speaks, he communicates, he can give us his wants.

I mean, he's not talkative. He's not - but the music therapist, she comes twice a week. This has made such a huge difference to our family, to our life, his ability to be educated, to provide self-care. And I mean, there is no one that was a bigger nonbeliever than me, and now, there is no one that is a bigger believer. These people are so, so important.

FLATOW: All right...

SUSAN: The oldest also had cancer, and we had music therapy for him. And when he was in the hospital, it was amazing. My question is these therapists are so vital...

FLATOW: Susan, let me - can you hang on - I'm going to keep you on. We have to go to a break but hang on...

SUSAN: OK.

FLATOW: ...and we'll come back...

SUSAN: I know.

FLATOW: ...with your question, OK? 1-800-989-8255 is our number, talking about music therapy with Oliver Sacks, Connie Tomaino and Joke Bradt, also with us is Andrew Rossetti. We'll be right back after this break. Stay with us.

(SOUNDBITE OF MUSIC)

FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR.

(SOUNDBITE OF MUSIC)

FLATOW: This is SCIENCE FRIDAY. I'm Ira Flatow. We're talking this hour about music to treat anxiety, pain, movement disorders, more with my guests Oliver Sacks, physician and professor of neurology and psychiatry at Columbia University Medical Center in New York; Connie Tomaino, executive director and co-founder of the Institute for Music and Neurological Function at the Beth Abraham Family of Health Services in the Bronx; and Joke Bradt, she is associate professor in creative arts therapies in the department - assistant professor in the Creative Arts Therapies Department at Drexel University in Philadelphia; Andrew Rossetti, music therapist in the Radiation Oncology Department at Beth Israel Medical Center.

Our number, 1-800-989-8255. When we went to the break, Susan in Tempe was on the line. Are you still there, Susan?

SUSAN: I'm still here.

FLATOW: You had a - you gave us - you told us a great story about your sons and music therapy helping them out and you - I cut you off when you said you had a question you wanted to ask.

SUSAN: My question is that the autism community now has the largest identifiable nonverbal population in our country and is growing. And yet, this service more than speech services or any other services that are provided, you know, either federally or by the state, has had the greatest cuts in funding of anything else. I know it's hard times. But how - I'd like to ask your panel. Since this service is totally vital to the autism community, how do we go about stopping this continued cutting to this service in particular? Because these kids need it.

FLATOW: All right. Let me - thanks for your call and thanks for that - for telling us about your experiences. And have a good holiday season. Thanks for calling.

SUSAN: Thank you. You too.

FLATOW: Let me go around the table. Oliver Sacks, you have any reaction to that?

SACKS: I'm - well, my mind goes back to 1973 when I was working at Bronx State Hospital on a ward of young patients, many of them autistic, and I often found that the only way I could connect or communicate with these patients was with music. And I - in fact, I brought my own piano to the hospital. I think it's probably still there. And people would cluster around the piano, people who otherwise I just couldn't access at all. So I have no doubt of the importance of music and music therapy for people with autism. But I can't address the other tormenting question of cutbacks.

FLATOW: Can anybody?

BRADT: Could I respond to that, Ira?

TOMAINO: Yes, Joke, go ahead.

FLATOW: Joke, go first, then I'll have Connie jump in there.

BRADT: Sure. I think, unfortunately, in this era of evidence-based practice where evidence really drives our health care industry, as well as our funding and reimbursement industry, we really need more evidence in terms of randomized control trials that show that this - that music therapy really is effective. We all know it is extremely effective with children with autism, but there are a lot of skeptical minds out there, like the caller was herself initially. Fortunately, we do have one Cochrane review out already, but it only included a few trials.

But I know that a research group in Norway, led by Christian Gold, just received a huge grant, and they will be doing a humongous randomized controlled trial, including seven different countries, on music therapy with autism. And the U.S. is one of the countries that will be involved with this. And I think that, hopefully, the trial will lead to good outcomes, and indeed, it will be able to show how effective music therapy is with this population. And I think if the outcomes are positive, that it will potentially have a large impact on policymaking related to music therapy services for autism.

FLATOW: Connie?

TOMAINO: Yeah. What Joke is saying is definitely the challenge, the need for evidence-based research in the arena of accountable care, which is a big driving force in medical reimbursement these days, unless an agency can show that the treatments that they're applying directly affect function, and cost effectiveness is a big challenge. And that happens whether it's in education, early education, early intervention or in stroke recovery. In some states, for example, traumatic brain injury, Medicaid waivers can be used to pay for music therapy services. But in other states, that's not possible. So even...

FLATOW: Does Medicare cover it?

TOMAINO: Medicare Part B for partial hospitalization but not in every aspect and not in every state. So each state also can dictate how those funds get allocated.

FLATOW: So you have to have some sort of good studies as Joke was saying to convince people that this is real...

TOMAINO: Right.

FLATOW: ...and does work.

TOMAINO: And I'll say that I was - about half a year ago, I was contacted by an insurance company from New Zealand, asking me to review a large meta-analysis they did for, basically, a summary of the available evidence for stroke patients, as well as autism. And their summary concluded that there was not enough evidence - and, of course, that means, again, randomized control trial outcomes that - so that there was not enough evidence to make them pay for music therapy services for autism.

BRADT: And fortunately, I was able to point into a couple of more studies that were relevant, and then told them we cannot just look at these quantitative studies. There are so many other good studies out there, and case studies out there that showed that music therapy is effective.

So now they concluded that they'll continue to pay on a case-by-case basis. But it was very sad to see that the insurance company, of course, only goes by the available evidence, and will not listen to stories like the caller and be convinced that they should be paying for this service.

FLATOW: Well, as the population ages and we're seeing more dementia cases, Oliver, and Connie, and Alzheimer's cases, you've said that you've seen patients respond well - Alzheimer's patients respond well to music, correct? I mean...

SACKS: Yes. Many, many. And far - and over the years and over the decades. And...

FLATOW: It's convincing when you see it.

SACKS: It's convincing when you see it. But one should be able to have a - the sort of randomized study which will convince the insurance company or a skeptical medical professional.

FLATOW: Connie?

TOMAINO: You know, now with the advancement in neuroscience research, I think some of the evidence for how and why music works therapeutically is being presented. And I think even their studies show how well the brain responds to music, especially, say, somebody with Alzheimer's disease. When they hear a piece of music that's familiar, a part of the brain that's wide enough is a part of the brain that's still intact and functional. And so as the insurers or government agencies see the evidence through basic sciences, as well as these types of gold standard research studies, we'll have the evidence we need to push forward.

FLATOW: Oliver, why is it that music therapy works for all these different disorders?

SACKS: Well, it addresses so many different parts of the brain which may be spared. But it also addresses the person and the self in a very deep, emotional way and does so in the context of a pattern, of a musical pattern, but specifically, say, we know that human beings, unlike chimpanzees, respond to a beat. You see this in children from the age of three or four, that they will move in resonance to a beat. And, say, for people with Parkinson's or whatever, the - they also respond to the beat, and this is crucial. But I endorse what Connie was just saying, that the - that when these careful brain imaging and other objective tests to show what's going on.

FLATOW: Does therapy work in conjunction with other modalities? Do you combine it with other things, music...

TOMAINO: Sure.

FLATOW: ...with visualization, other kinds of - I...

TOMAINO: Well, Andrew spoke about guided imagery with music. Many times with co-treat in a rehab setting, for example, we'll co-treat with a speech therapist if that can facilitate how well the patient understands what they need to do. And the music therapist will take cues from the speech therapists about what phrases to use or what targeted words need to be addressed, how the music therapist that - will manipulate the music to allow for that to happen. In physical therapy, occupational therapy, the music therapist will provide the timed music, the rhythmic stimulus to facilitate gait improvement in those patients.

And then what Andrew was talking about working with the environment and working with the other staff in the unit to really give the patient-centered care that's really needed. And music therapy enhances that very much so.

FLATOW: Andrew, you were saying about how just playing music sometimes makes people feel better. I mean, is there...

ROSSETTI: Well, yes. I believe that's true. But I also believe that if there is a clinical goal to the way the music's being played, which is one of the reasons why we try and use more live music than pre-recorded, that the benefits can be far greater. You can address any number of things.

FLATOW: My question about this is: If we are always into preventive medicine and we try to prevent things and - is there - should we be having a dosage of music every day as a preventive medicine...

(SOUNDBITE OF LAUGHTER)

TOMAINO: Well...

FLATOW: ...and find it - I mean, should you like - people take supplements, right? They take vitamin supplements or whatever, thinking these are things - possibly should people be taking - I'm just thinking out loud here. Should they be taking some music?

TOMAINO: Think of - think about how people are using music every day in their life to get through, you know, people listening to music on the subway on the way to work. I think one of the challenges in the field of music therapy is music is ubiquitous in our life. It's - we're surrounded by it, and we use it ourselves very therapeutically, maybe without knowing it. But we use it to exercise. We use it to get motivated. We use it to go to sleep. And because it's so pervasive, people don't think - they don't think of therapy or music, as a treatment, is a legitimate field. I think that's a challenge the field of music therapy has always been up against, because people say, of course. Of course it's therapy. Of course it's therapeutic. We can all do that.

What Joke is saying with the research and all the work that the Music Therapy Association is trying to do is to bring the evidence of the field of music therapy where it is important. And, of course, a lot of us are working in preventive care, as well, in wellness programs, designing programs to help people with early Alzheimer's maintain memory function and attention as long as possible, people with Parkinson's disease being able to keep the integrity of their speech and flexibility of movement as long as possible, so they don't need as much medication as they would without the music therapy interventions. So we're very much involved in the wellness efforts, as well as treatment efforts.

FLATOW: Mm-hmm. And people want to learn more about it. If they want to become - if you want to become a music therapist, what do you do?

TOMAINO: You go to www.musictherapy.org, look up the field of music therapy. Look at the requirements, what universities have programs throughout the United States. There are resources in every state where they can visit music therapists and see the work firsthand.

FLATOW: And - yeah. And that was my next question. If you believe you could benefit or you know someone who could benefit from music therapy...

TOMAINO: Also check...

FLATOW: ...where do you go?

TOMAINO: Go to the same place. You go to - Google music therapists in your state, but go to AMTA, which is the American Music Therapy Association and, like I said, musictherapy.org. You could call their office, find out where music therapists are in your location.

FLATOW: All right. Thank you all for taking time to be with us today. Oliver Sacks, a physician and professor of neurology and psychiatry at Columbia University Medical Center. His latest book is "The Mind's Eye." And he's told us he's working on a new book that will be coming out next year. Connie Tomaino is executive director and co-founder of the Institute for Music and Neurologic Function at the Beth Abraham Family of Health Services in the Bronx. Joke Bradt is associate professor in the creative arts therapies department at Drexel University in Philadelphia. And I also want to make sure I get your credentials right. Andrew Rossetti is music therapist in the radiation oncology department at Beth Israel Medical Center. Thank you all for taking time to be with us today.

TOMAINO: A pleasure.

SACKS: A pleasure to be here.

BRADT: A pleasure. Thank you.

FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY, from NPR. Transcript provided by NPR, Copyright National Public Radio.

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