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Sunday, November 20, 2011

Music and the Brain on CBC

Episode 52- Music & the Brain

Giffords Musical Recovery

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And the show kicks off this week with a story that examines what we know and don't know about the brain as it pertains to the recovery and therapy of Gabrielle Giffords.

When U.S. Congresswoman Gabrielle Giffords was shot last January in a parking lot in Tuscon, the bullet entered just over her left eye, travelled the length of the left hemisphere of her brain, and exited.

Gabrielle Giffords' wound was catastrophic, but not fatal.


The left hemisphere of the brain is famously the side of the brain that controls handedness, motor control and crucially, language. The interconnections of language- the associations, the matchings, semantic decisions, naming things, hierarchical values of words- all of these complex organizations the brain undertakes when processing speech seem to happen in the left hemisphere.

Two left hemisphere regions of the brain, Broca's area and Wernicke's area are implicated in cases of language dysfunction or aphasia. Writing about Wernicke's region in 1976, neurophysiologist Joe Bogen stated "If a person has a cerebral lesion that produces a loss of language far out of proportion to the loss of intelligence, the odds are about 50 to 1 that the lesion is in the left hemisphere."

The Connection is Music

Less than a month after the bullet pierced her left hemisphere, Gabrielle Giffords met with music therapist Maegan Morrow at at TIRR Memorial Hermann Rehabilitation Hospital in Houston. Maegan told me this week on Day 6 that she knew going into the meeting that Giffords wasn't able to vocalize at all.

Maegan sang a song to the mute Congresswoman. It was, she says,"A very familiar song to all of us, 'Happy Birthday". And I left the end of the phrase out and tried to get Gabby to sing along with me." Giffords didn't sing.

Instead, she reached out her hand and grabbed the hand of the therapist to physically but silently complete the missing word of the phrase "Happy Birthday to ...."

Music became the cognitive link between patient and therapist.

Maegan says "She looked up at me and she grabbed my hand. And I knew that she was trying to communicate with me through her gestures." Music opened the door. "I knew that there was awareness there", says Maegan, "and she knew that she wanted to fill in that blank in any way possible. So I knew there would be more breakthroughs after that."
Music Gets In

How does music find a pathway inside a damaged brain that regular speech can't negotiate? Maegan says it has to do with the part of the brain music comes from.

"Music centres are all over the brain. I might be able to retrieve lyrics from the right side from the middle from the back of the brain. There's so many components to music that I can tap in that way to reach words again and to reformulate them in the brain."

In terms of human evolution, speech is relatively recent addition to our compartmentalized brains. Some believe music may precede it. There's no doubt that toddlers babble and vocalize long before they speak.

"It used to be thought that music was a superfluous thing, and no one understood why it developed from an evolutionary standpoint," said Michael De Georgia, director of the Center for Music and Medicine at Case Western Reserve University's Medical Center in Cleveland.

"In the last 10 years, we've just started to understand how broad and diffuse the effect of music is on all parts of the brain," he added. "We are just starting to understand how powerful music can be. We don't know what the limits are."
Melodic Intonation Therapy
One of the therapies Maegan practiced with Congresswoman Giffords is called Melodic Intonation Therapy. It's an intensive program developed after researchers noticed that patients with severe aphasia could sing words and phrases they could no longer speak.

In the ABC television special last week, Maegan is seen working with Giffords trying to get her to say the word "light". Giffords can't vocalize it and she's frustrated. Then, moments later, as Maegan sings the spiritual "This Little Light of Mine" Giffords sings forcefully, perfectly forming the word light. It's astonishing to see, and you can feel Giffords' connection with the words that moments earlier were completely lost.

Maegan says the therapy requires long hours in daily session.

"I would see her a few times a day every day and work through speech stimulation with familiar songs. And I knew I could get some kind of voicing out of that. And once I did then I knew that we could go further with more lyrics, bringing more words back into her functional life and then get phrases she could use with her family and friends."

The theory of Melodic Intonation Therapy or MIT is that music engages areas of the brain in the right hemisphere that become useful in restoring articulation and speech in the damaged left hemisphere.

Gottfried Schlaug, Director of the Music, Neuroimaging and Stroke Recovery Laboratories, Beth Deaconess Israel Medical Center and Harvard Medical School co-authored one of the first studies to use functional neuroimaging to observe the brains of people who'd undergone MIT.

The paper, published in the journal Future Neurology concludes:

"The observed brain changes following treatment indicate that MIT's unique engagement of predominantly right hemispheric brain regions accounts for its facilitating effect."

Or as Maegan describes it on Day 6: "We call this concept neuroplasticity. The brain is kind of re-wiring itself. I actually have patients who dont have a left side of the brain anymore. They have taken it away. But the whole other side of the brain took over and learned to talk again."

Music = Brainpower

Gabby Giffords' recovery has advanced to the point that she was able to release a recorded message to her constituents on Tuesday. Her voice sounds strong, but it's stilted. The message suggests fluency may still be an issue as the Congresswoman weighs next year's election.

Meanwhile, as research continues into the therapeutic power of music, some neurologists like Gottfried Schlaug wonder if we are underestimating the role music plays in our everyday lives.

"Theres enough data out there," he says, "that would support a strong role of arts in general and certainly music making in our general education system."

From "This Little Light of Mine" to Bach, we are only just beginning to understand the ways music lights up our brain.

Brent Bambury @CBCDay6