The Healing Power of Music: Parkinson’s Disease
Isabel Shen , BSc candidate
Medical Sciences, Faculty of Science
The Healing Power of Music: Parkinson’s Disease
Disease is more than just a malfunction of the human body. Behind every disease is a real person with their own stories, passions, and values. Medical treatments for disease are undoubtedly advancing to new heights, but what we are missing is a touch of humanity— this is what music can bring.
Music therapy uses techniques such as singing and music listening in a therapeutic setting (CAMT, 2020). Unlike traditional surgical or pharmacological treatments, music therapy does not cause adverse side effects, it’s non-invasive, and it’s easily accessible (Koshimori & Thaut, 2018). Research has shown that music may be beneficial for people with Parkinson’s in particular, having a positive impact on its motor, cognitive, and psychological symptoms (Pohl et al., 2013).
Parkinson’s (PD) is a neurodegenerative, chronic brain disorder characterized by tremor, impaired balance and coordination, slowness of movement, and gait (NIH, 2017). More specifically, PD is caused by neurodegeneration in the substantia nigra of the basal ganglia (NHS, 2019). Under non-PD brain conditions, central pattern generators (CPGs) in the brain execute auditory and movement processing together using the basal ganglia-thalamocortical (BGTC) network (Lesiuk et al., 2018). CPGs are neural circuits that carry timing information to produce neural patterns that drive rhythmic movements like walking without the need of any rhythmic stimuli (Barko, 2018). In PD, the BGTC network is damaged. However, music activates another pathway: the cerebellar-thalamocortical (CTC) network. In doing so, processing goes through the cerebellum to bypass the damaged region, and achieve the same result (Pohl, 2018). One specific music intervention that uses this mechanism is Rhythmic-Auditory Stimulation (RAS), where predictable auditory cues often embedded in music allow the user to anticipate and synchronize their step with the beat (Koshimori & Thaut, 2018). Thaut et al. (2018) studied the effect of daily RAS training on the fall rate of participants with PD. After 24 weeks, they found self-reported improvements in fall rates and confidence in motor abilities, in addition to gait parameters such as velocity (which increased by 12 meters/minute). Meanwhile, for the control group who did not practice RAS from week 8-16, these measures deteriorated in the weeks without RAS training, further highlighting the therapeutic significance of RAS (Thaut et al., 2018).
Music interventions can also use internal rather than external auditory cues, where one matches their steps to their own singing. Harrison et al. (2018) investigated the effect of internal versus external auditory cueing on forward and backward walking in people with PD. For the internal cue condition, participants listened to a song and then sang without the track while walking. For the external cue condition, the song played while they walked. Researchers found that internal auditory cueing had a greater benefit on gait characteristics for backward walking, as well as increased cadence and reduced gait variability for both directions. It was proposed that internal cueing holds the advantage of flexibility and backwards walking is a relatively challenging movement that would benefit from this trait (Harrison et al., 2018). As explained by a participant in another external vs internal auditory cueing study, “the problem with the metronome was that once you lost it, there was no way to find your way back” (Rose et al., 2019). Nonetheless, research supports the use of both types of cueing on improving physical symptoms of PD.
According to studies by Broeders and Pedersen, 25%-50% of people with PD develop cognitive impairment within 5 years of diagnosis (Yang et al., 2016). Improving cognition requires cognition to be practiced. The renowned experiment that established this notion showed that rats had increased brain growth and learning capacities in enriched environments where there were interesting objects that stimulated mental exercise (APDA, 2021). Music is one form of cognitive training as it activates the dopaminergic mesolimbic system which regulates cognitive functions (Pohl, 2018). The brains of musicians are also known as models for neuroplasticity, suggesting that through music, the brain changes and could improve cognition (Pohl, 2018). One example of how music may improve a specific cognitive function affected by PD is attention. Pohl (2018) suggests that rhythmic synchronization that uses external auditory cues enhances attention because the sensory-motor coupling mechanisms interact with attention oscillators (internal rhythmic processes in the brain). For music interventions that use internal auditory cues or even just instrument playing, musicians must use divided attention mechanisms to simultaneously process different stimuli of lyrics, pitch etc. (Thaut, 2010). Practicing divided attention mechanisms can ultimately translate to an improvement in task shifting, a particular attention-related difficulty for those with PD (Pohl et al., 2018).
Music also has a significant effect on the psychological symptoms of PD. Music listening for example, benefits moods as it involves the reward circuitry, which releases endorphin, dopamine (associated with pleasure and motivation) and oxytocin (associated with the alleviation of stress) from the ventral striatum (Irons et al., 2020). Soft and slow music can also induce relaxation by reducing heart rate, stress and soothing pain to alter pain perception (Tikka & Nizamie, 2014). These effects are especially important for people with PD, whose treatment processes are quite physically strenuous. Moreover, as music therapy is a more natural and engaging form of treatment, and this has been shown to further motivate patients to continue their treatment journey while increasing their eagerness to move. Namely, in a music and PD study by Pohl et al. (2013), there was a 93% adherence rate to the intervention in addition to improvements in quality of life.
The science is clear. Music therapy represents an important avenue for treatment of Parkinson’s, with potential to improve not just its physical, but also its cognitive and psychological symptoms. Whether you are an aspiring musician, healthcare provider, or simply someone who cares, if you are someone with PD you can utilize the power of music to enhance the health and well-being of those living with Parkinson’s.
References
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