For the Disabled Brain, the Best Medicine May be Low-tech and Musical

For Aiden, who has autism, this appropriate answer is the mark of real progress. When first diagnosed at 3, Aiden barely spoke at all and shunned interaction with his classmates, preferring to peer at the digital display of the classroom’s CD player. Since most autistic children have an affinity for music, Brennan teaches verbal skills through song, using the music as "training wheels" that he slowly takes away over time, eventually leaving the pair conversing in ordinary speech.

For brains affected by autism, which occurs in 1 out of 150 children, or other serious neurological conditions like Alzheimer’s disease, severe depression, and stroke, music can be a powerful form of treatment.

Rather than relying on high-tech tools or cutting-edge drugs, music therapists have devised sonic exercises that help the brain heal, soothe, or re-train itself. Though well-established in the Veteran’s Affairs (V.A.) system and in some psychiatric hospitals, and supported by a growing body of research, music therapy is dogged by insurer skepticism that music is not medicine in the same way as surgery. Even when music therapy is an effective way to reduce the symptoms of hard-to-treat neurological conditions, it is often available only to relatively well-off patients. Brennan’s clients in affluent Marin County, just north of San Francisco, pay $100 per hour out-of-pocket for his services, although fees vary widely depending on specialty.

"Music is patterns and structure, and kids with autism are driven toward that and they attend to patterns and structure," Brennan says, who calls his practice "Developmental Rhythms." A former Peace Corps volunteer, Brennan just finished his master’s degree in music and is in the process of completing his various certifications as an autism specialist. "Joint attention is such a challenge for kids with autism. But once you have their attention, you can teach them a lot of different things."

"His speech was really delayed, and still is," says Aiden’s father Matthew Stewart, who works as an electrical contractor in nearby Fairfax, Calif. "But what’s really wonderful about music therapy is that it made him want to speak."

Brennan is a pioneer in applying the codified set of techniques known as "neurologic music therapy" (NMT) to autism, an area where music therapy research is suggestive but not definitive. NMT was originally devised by Michael Thaut, a professor of neuroscience and music at Colorado State University, as a way to provide uniform, scientifically sound standards for music therapy applications. NMT has had success helping victims of neurological diseases like stroke, brain injury, and Parkinson’s disease improve their ability to walk steadily, and shows promise as a tool for speech rehabilitation.

"Traditional music therapy struggles with the science," Thaut says, author of the 2005 book "Rhythm, Music, and the Brain." "Neurologic music therapy has a very good research base that’s developed over the past 15 to 20 years. The latest area that’s been coming into play in the last few years is cognitive training, using music for attention training, memory training, and executive function."

Cognitive training is particularly helpful for veterans who have suffered traumatic brain injuries, from causes like combat, toxic exposure, or stroke. The recovery process requires hours of painstaking memory, attention, and decision-making exercises, with the goal of aiding the injured brain in regenerating new cells.

James Gardiner, a neuropsychologist at the V.A. Black Hills Health Care System in South Dakota uses more than 80 NMT techniques to make the exercises more fun and engaging. Music stimulates the limbic system, the part of the brain involved with emotions.

"With music, you’re dealing with a more desirable and energetic way of approaching things," Gardiner says. "I’ve found that when I had people around tables, at computers, the mood is one of work and drudgery. Whereas with music, the mood is very upbeat."

The musical exercises are also a way to connect with recovering soldiers who are used to stoically enduring suffering – not actively working on it, or talking about it, with others. They are frequently battling depression because of diminished memory and decision-making skills.

"’As veterans,-‘ I tell them, ‘Your brain cells are like new recruits – or like a bunch of soldiers that have gone awry, and headed out all over the hills and, down by the valleys and streams,’ " says Gardiner. "Music is what blows the bugle call of assembly – and gets everyone to march in order, so that everyone is together. And they like that metaphor."

Music therapy has a long history in military hospitals, as the discipline began after World War II as a way to treat veterans struggling with the psychological fallout of combat – and the practice continues today in facilities like the Veterans Home of California in Yountville, CA. Through music, patients like Rick have gingerly re-entered relationships with other people (his therapist asked that his last name not be used). Held for two years as a prisoner of war in Vietnam, he was also a witness to the My Lai Massacre in 1968. His war memories continue to cause him the intense anxiety typical of Post-Traumatic Stress Disorder , and he is also afflicted with schizophrenia and incipient dementia. After his return to the United States he was placed in a locked facility as a threat to himself or others, and his levels of anxiety were so high that he refused roommates and had little human contact.

But he has made large strides in recent years, moving out of the locked facility and accepting a roommate. In addition to drawing, Rick sets his own poems to music, and also picks up his guitar and harmonica to play the songs of his youth, like "Travelin’ Man" and "Blowin’ in the Wind."

The Home’s music therapy internship director, Megan Edmontson, who plays with Rick once a week, points out how singing has helped lessen his anxiety, such that he now will occasionally venture into the main ward and give brief concerts for the other residents. Singing also helps reduce his tendency toward "word salad," in which a person with schizophrenia loses the ability to differentiate his own words, instead slamming them into a slurred jumble.

"The individuals here who have speech impairments, no matter what the condition may be, whether it’s a stroke or some kind of brain trauma, they can sing clearly. It’s audible, there’s no strain, there’s nothing blocking what they have to say," Edmontson says. "But when you take the music away and are speaking with them in a normal conversation, it’s difficult for them just to put the words together."

Multiple therapeutic techniques draw their power from that key insight, that a disabled brain can still use words that are embedded in music, even if normal language use is otherwise impaired. Pierre Brennan points to research suggesting that autistic children hear language "musically," meaning that their brains sometimes process language with the right side of the brain, rather than with the left-side where language use is typically centered. For reasons that experts do not fully understand, Alzheimer’s disease ravages brain function, but leaves long-term musical memory relatively untouched. That means that even severely-impaired Alzheimer’s patients can still remember favorite songs of the past, and music therapists can use these song memories to get the attention of patients to do basic physical exercise, and also to improve mood.

Though both Gardiner and Edmontson work with Alzheimer’s patients in the V.A. system, skilled nursing homes that care for civilian Alzheimer’s patients typically view music therapy as a luxury that patients can forego.

"I think music therapy would be very helpful, but most nursing homes are for-profit," says Jeanie Kayser-Jones, a UCSF professor of nursing who has studied nursing homes for 25 years. "And music therapy is not a requirement, so they don’t provide it."

It is with conditions like Alzheimer’s and autism, where music therapy can reduce symptoms but not provide a definitive cure that funding tends to be most scarce. Quality of care becomes a question of ability to pay out-of-pocket – and whether the family is willing to battle insurers or state agencies for funding.

"Our system does not work for the meek, the timid, or the afraid," says Judi Sheppard, the mother of a severely autistic 13-year-old boy in San Rafael, Calif. Sheppard was able to get her local California regional center, which allocates disability funding, to pay for music therapy for her son by twice appealing denials. "People that are afraid and don’t want to ‘go against the man,’ aren’t going to get anything."