Despite our increasingly sophisticated understanding of how to detect and treat strokes, they remain the third-biggest killer and leading cause of severe disability in the UK. Every five minutes, someone in the UK has a stroke – that’s around 150,000 people a year. About three-quarters of these strokes are ‘ischaemic’: caused by a blockage of the oxygen-rich blood flowing to the brain. The rest are mainly ‘bleeding strokes’, or cerebral haemorrhages, which occur when a brain aneurysm ruptures or a weak blood vessel in the brain starts to leak.
Stroke: signs, symptoms and risk factors
Regaining post-stroke faculties
Whatever the cause, a stroke can be devastating, both for the sufferer and their loved ones. But the good news is that prompt treatment can help reduce the damage to a person’s brain and improve their chances of a full recovery. And there is growing evidence that, even when damage is done, music therapy can help stroke patients recover some of their lost faculties. For example, in
July last year, a review of seven separate studies by the internationally respected Cochrane Collaboration found that rhythmic auditory stimulation (RAS) improved walking speed far more effectively than standard movement therapy. RAS is a type of rehabilitative therapy in which, for example, the patient uses a metronome-like auditory stimulus as a cue to move from one target to another. These rhythmic movements are smoother and more functional than those performed naturally.
Using RAS therapy, walking speed improved by an average of 14 metres per minute compared with standard movement therapy, helped patients take longer steps and, in some cases, improved arm movements.
Dr Concetta Tomaino, executive director of the Institute for Music and Neurological Function at CenterLight Health System in New York, explains that RAS is just one tool at the music therapist’s disposal. ‘For those with movement-related problems, such as weakness, balance and coordination, the music therapist will work with the patient to establish what components of music – rhythm, pitch modulation, melody – are the most effective at cueing the targeted skills,’ she says. ‘For example, a patient with a left-side weakness who is dragging his leg may automatically lift that leg if asked to follow a rhythm while they walk.’
Dr Tomaino and her team also use music to treat aphasia – when someone loses their ability to find the right word or form a sentence. Structured, repetitive use of familiar lyrics helps to improve patients’ articulation, while special breathing exercises increase their lung power, making speech more intelligible. Music can also be used to help with cognition. For those with attention problems, engaging in rhythm-based activities such as repetitive rhythmic songs and games can improve focus and listening skills.
‘Music and musical structures are used to enhance all aspects of cognition, including attention, memory, organisation and problem-solving. We even use music as a mnemonic device to support memory recall – for example creating a ten-note jingle to match a ten-digit phone number,’ says Dr Tomaino.
Learn more about aphasia
Music is positive
Researchers are still not clear exactly why music has such powerful healing properties, but the results are so positive that music therapy is currently one of the most exciting fields in rehabilitative medicine.
In addition to stroke, it’s being used to treat patients with neurological disorders such as Parkinson’s disease and multiple sclerosis. MRI (magnetic resonance imaging) technology shows parts of the brain associated with pleasure and reward ‘light up’ in response to music.
These scans partially explain why music and language, in particular, seem interlinked, according to science writer Philip Ball. ‘Music and language seem to share some of the same brain machinery,’ he says. ‘Scanning technologies show that the same bits of the brain light up when we encounter something that seems odd about musical structure, like a misplaced chord, as they
do when we process linguistic or grammatical errors.’
Ball cites the example of Russian composer Vissarion Shebalin, who suffered a stroke towards the end of his life (he died in 1963). ‘It left him unable to make sense of language, but he could still compose eloquent symphonies. So it seems there’s still some bit of the brain that can deal with logical processing, even when it can’t manage language. But MRI is still a fairly crude way of measuring that, because it can’t tell us what the brain is doing, just which bits are doing it.’
Learn more about Parkinson's disease
MRI scanning is key
Nevertheless, MRI scanning is a key tool for assessing the damage done to a stroke patient’s brain. And, like their US counterparts, speech and language therapists in the UK use a combination of MRI scans and linguistic assessments to first check for damage, then help stroke patients regain their speech, movement and cognition.
Pam Enderby, Professor of Community Rehabilitation at the University of Sheffield, says music can be life-changing for some patients. ‘People get very frustrated after a stroke. Trying to say something quite normally and not being able to get your message across is frustrating enough. But if you can’t express yourself at all, the frustration is almost unimaginable.’
Slowly but surely, therapists such as Professor Enderby help these patients regain their ability to communicate, which has a huge impact on their self-esteem. They first encourage them to sing phrases such as ‘I want a glass of water’ that they cannot speak. Over time, the patients learn to say these phrases without having to sing them.
‘Some people can still sing even when they can’t speak,’ explains Professor Enderby, ‘because they retain the words of familiar songs. If you feel like everything that comes out of your mouth is nonsense, then manage to express something positive and pleasant, it’s very encouraging.’
This approach, Melodic Intonation Therapy (MIT), was the subject of a recent study on 12 patients at Harvard Medical School whose speech had been impaired by strokes. The patients were taught
to sing simple phrases and, after frequent repetiton, they gradually learned to turn the sung words into normal speech.
And not only did their verbal abilities improve, but they maintained these improvements for up to a month after the therapy ended. This suggests that the brain can be ‘re-wired’, because the patients with damage to the left side of their brain – which is typically involved in speech – learned to use a region in the right side of their brains associated with music for sing-song speech.
Although researchers knew that patients who can’t speak clearly often do better when they sing words, this is the first time anyone has used brain imaging to prove exactly why this occurs. And, although the therapy is intensive – it lasts for up to 16 weeks with 90-minute sessions five days a week – the results seem to be permanent.
Choirs can help
Aiming to maximise these benefits, as well as providing much-needed peer support, choirs and singing groups are springing up across the UK for stroke patients and others with neurological difficulties.
A London-based choir, Sing for Joy, helps people with Parkinson’s and MS. And another such group in West Sussex, the Aphasia Chorus, is made up of stroke survivors with aphasia from local Stroke Association support groups. Lou Beckerman, a community musician and nurse, leads the group through a series of warm-up exercises before launching into a medley of old favourites such as Here Comes the Sun and Singin’ in the Rain. ‘It was found that people recovering from strokes who have communication difficulties surprised themselves by using song as another way to communicate,’ she says. ‘What is lovely for me is watching people realise that even though they find conversation difficult, songs and lyrics are still in there.’
Norman Watson, 60, is a keen member of the Chorus. After his near-fatal stroke in April 2005 he was left with very limited speech and mobility problems down his right side. Norman also has cognitive problems, and suffers from depression and fatigue. Despite these challenges, he regularly attends the group and is a very enthusiastic member. ‘It lifts my spirits and always leaves me feeling very happy,’ he says. ‘I enjoy the social aspect, feeling part of a group and watching others enjoying themselves, too. I surprised myself, because I thought I couldn’t sing due to aphasia, but I can participate fully. I have lost my inhibitions and rekindled my love for music.’
Norman’s carer, Angie Luss, has watched him flourish as his confidence and speech have improved. ‘The singing has really helped lift Norman’s spirits,’ she says. ‘Whenever he’s asked what he enjoys doing nowadays, the answer is always his singing. It has made him much more determined to speak and he’s no longer afraid of making mistakes. He perseveres until he gets the words out.’
Perhaps one day, we will eradicate stroke altogether. Until then, it is reassuring to know that stroke patients are finding their voice when all hope seems lost.
How music helps you feel better
The Stroke Association - www.stroke.org.uk
The Music Instinct: How Music Works and Why We Can’t Do Without It by Philip Ball (Vintage, £10.99)