Speech therapists have long used music to help patients regain their voices after stroke or brain injury.
Today’s music therapists are going even further, developing strategies that use music on patients with Parkinson’s disease, spinal cord injuries, cognitive issues, and more.
Hear from Neurologic Music Therapist Caitlin Hebb about how the rhythm and rhyme of music work on memory, gait, and language.
Plus… what’s that earworm?
Phil Stieg: Hello. I’d like to welcome Caitlin Hebb, Clinical Operations Manager and a neurologic music therapy fellow at Med Rhythms Therapy. She graduated from Berkeley College of Music with a degree in music therapy and received her fellowship in NMT from the Academy of Neurologic Music Therapy. She serves on the NMT Academy Advisory Council.
Let’s learn today how music is used to induce brain plasticity and neurologic recovery in areas such as sensory motor, speech, language, and cognitive skills. Please learn with me about our advanced understanding of the important role of music in our lives. Caitlin, thank you for being with us today.
Caitlin Hebb: Thank you for having me.
Phil Stieg: So you went to college at the Berkeley School of Music to learn music therapy. What motivated you to become a therapist?
Caitlin Hebb: Yeah, I grew up I mean, I think my first performance, I was probably three years old with my brother, who was five. We were recruited for almost every single wedding, family, friend, wedding. We were the wedding singers. So that started very early, my love for music. And as I grew older, I was like, I don’t love performing. I don’t like being the center of the attention.
But I did know that music had this really profound effect on me. And so I was happy to find music therapy as a field because it meant that I could actually try to recreate that with the people I’m serving.
When you see the work, then you just are immediately drawn to it. And the moment I stepped into — I did my internship at Spaulding Rehab — the moment I stepped into and I saw music in that way, in that capacity, it was a done deal for me.
Phil Stieg: If I had to ask you what are the core principles that you try to apply in NMT, what would you say?
Caitlin Hebb: The idea is that we’re using music to kind of reroute the brain. Right. So I like to give the example of that, every day to work, I take route 93. That’s what I do. I don’t even need the GPS to do that right – except for when there’s traffic. And in that case I take 95 because that gets me around 93. And so I like to think of it in that way, is that when there’s been damage to the left part of our brain where speech and language are predominantly housed, there’s traffic there, there’s been damage to that particular area. We’re going to use a different route. And that is recruitment from the right hemisphere to really stimulate language and access language and even further help with motor speech. Music can address both of those areas. So that’s kind of an easy way to explain it I guess.
Phil Stieg: So you’re famous on YouTube for helping an individual that’s had a stroke say their name using music. Tell us what’s going on there.
Caitlin Hebb: Yes. So that individual was someone that the clinician had actually met on an inpatient at a hospital first, and had started to work with them as well as co-treating with speech therapy. They had both expressive aphasia, but they also had apraxia or this motor planning deficit. That made it very challenging for him to get out any words, both the initiation of language and then the access and recruitment of language.
When the music therapist started singing, he had a fantastic response. He would start humming along and you could tell there were some approximations, there were some accurate sounds that were coming through. So the therapist did both familiar singing and then also did melodic intonation therapy, where they’re actually trying to access language.
Melodic intonation therapy is the intervention where you’re doing these in toned phrases, I’m Caitlin. I’m Caitlin, and singing it over and over again. And so he did both of those, which then over time and repetition, created this really profound neuroplastic change where the patient was able to not only say the phrases, but then also the singing turned into, from humming, turned into full words, where he was able to actually produce the right words.
Phil Stieg: What’s amazing to me is clearly we don’t have the answers to why this occurs. I mean, people have been studying speech function in the brain for over 100 years. And what’s amazing is the difference though, in function for speech versus the function for singing and music. Can you explain to us what parts of the brain are activated by music versus just pure speech?
Caitlin Hebb: Yeah, so there’s this bundle of fibers called the arcuate fasciculus, this fiber track that connects the speech and language to motor cortex that is connected to the right hemisphere of our brain. And that track is the track that we’re trying to reestablish. We’re trying to kind of recruit from to help reroute our brain or create that neuroplastic change.
There’s actually shown that if you train that enough, that you can actually thicken that track and thicken the communication that’s happening. And so that’s the neural pathway we’re trying to activate to use music, or singing specifically, versus just speaking.
Phil Stieg: There’s over a dozen techniques that I see you apply in NMT. Define entrainment for me,
Caitlin Hebb: One of the most crucial elements of music that we use is rhythm, and this idea that we can use rhythmic entrainment or our brain’s ability to synchronize with the rhythm, that drives a lot of the interventions we do.
Entrainment is, what’s happening, is that our brain is receiving those signals and then is lining up with a motor response. So you have auditory and motor and they’re firing at the same time and your brain is anticipating and kind of aligning the two.
Phil Stieg: So for the rest of us common folk out here, it’s a little bit like you hear some music and all of a sudden you find yourself tapping your foot. Right? So then I have to ask, I have to believe that you’ve encountered people with absolutely no rhythm whatsoever. So what do you do in that scenario?
Caitlin Hebb: I do encounter that, but I find that, because walking again is more rhythmic, I find that less. I would say it’s probably close to 97% of the population can entrain to a beat. We just might not all be good dancers.
Phil Stieg: So give me an example of what the deficit is, what a patient might have, and then how you would use music to elicit a motor response.
Caitlin Hebb: Yeah, I will give the example of someone walking, right? So walking is actually naturally rhythmic until it’s not. So let’s say we’ve had a stroke or we have Parkinson’s – something is impacting the way that that person is walking. That could be that their balance is poor. They could have asymmetry or poor coordination. And so what we would do is we would first kind of assess where that person is walking.
So we want to see what’s their current cadence, their current gate speed. What does their walking look like from an observational standpoint? From there we’re going to use the music to modulate and change their gait pattern and their cadence. So I might start with where they’re walking, but then I’m going to change the music to change the function.
Phil Stieg: How does that happen? Give me an example.
Caitlin Hebb: So the intervention I’m alluding to, it’s called rhythmic auditory stimulation. Again, it’s very much based on how we perceive rhythm. And we use rhythm.
So for someone with Parkinson’s, maybe they have that high cadence, that really high shuffling step pattern, the music then we might start there. But we are actually going to decrease the cadence or decrease the tempo that we’re playing. And our hope is to increase their step length. Right? So we want to decrease the shuffling.
Phil Stieg: What about for the average aging person that loses a little bit of their proprioception, the sense of where their feet are and their body is in relation to their feet? Would NMT be good for them?
Caitlin Hebb: 100%? Absolutely. Again, you’re creating this environment where you’re giving their brain something that actually it’s seeking for. It’s that pattern recognition. And that really helps with a lot of areas of our walking.
I’m going to encourage you to probably walk a little bit faster than maybe initially you’re comfortable with. And that’s because I know the faster we go, the more we get to that normal cadence range, your brain is going to kick in and it’s going to say, oh, I’ve done this before, this is normal to me, this is automatic.
Phil Stieg: In regard to the kind of music you use, I’m assuming that for one person you might use rap, another person you might use Frank Sinatra. The next person you might use some classical music, correct?
Caitlin Hebb: Oh, yeah, I’m a great rapper.
Phil Stieg: But I bet you never start with Stravinsky or something kind of arhythmic. Have you ever had that experience where you played something kind of with no absolute rhythm? Have you tried that experiment and see what it does to a person’s gait?
Caitlin Hebb: Oh, it makes it worse, for sure.
Phil Stieg: It does. Okay, so common sense prevails. I like that.
Caitlin Hebb: So most of the time in clinic, I’m actually playing the music, so I play guitar as well. I’m playing and singing. And so that’s kind of the nice thing about live music is, I can change the rhythmic structure of a song, I can make a reggae song have a strong one and three beat, instead of that two and four.
[Musical example]
And so I can manipulate music to address the goals that I’m looking for.
Phil Stieg: Give me an example of one of your great successes. What makes you get up in the morning, say, Ha! I want to do that again?
Caitlin Hebb: That’s a really hard question because I feel like I have that moment with almost every patient that I’ve worked with.
Phil Stieg: That’s fortunate. So give me one classic example.
Caitlin Hebb: Yeah, I can give you an example of someone that I worked with that had more of a spinal cord injury. A young woman. My typical consultation, I saw, okay, we’re going to work on gate training. We’re going to work on walking using music.
And I saw the moment she started entraining to the rhythmic stimulus that her gait pattern had increased. But then she started getting emotional and I was like, oh, I’m so sorry, I didn’t mean to push you too much. And she was like, “no, I’ve just never walked like this in all of my treatment. I’ve never walked like this before.” And it took me back because I was like, oh, exactly, this is what we do.
This is the process. And so it was one of those moments where I was like, I feel good about the impact I can have on this person.
(Interstitial Theme Music)
Narrator: Sometimes they just get stuck in your head. You don’t know how it got there or how you’re ever going to get it to stop. It’s that most curious (and occasionally annoying) musical phenomenon – the earworm.
The experience of music involves many different parts of the brain. This is especially true for Earworms. Despite the name, we are relieved to report these musical fragments are not actual worms, nor do they actually reside inside your ears.
Researchers at Dartmouth University have found that earworms seem to reside in the auditory cortex, which functions somewhat like your brain’s iPod. As part of the study, they played familiar tunes to volunteers while scanning their brains in an MRI machine.
Catchy tune fade under. Subject’s brain hums along
As the volunteers listened to the music, their auditory cortex lit up. But when the music suddenly cut out, the auditory cortex kept going.
Music cuts out. Subject’s brain hums by itself
The tune played on in their heads, and an earworm had been hatched! The researchers likened this to perception in reverse – music coming from memories deep inside your head, instead of sounds from outside your head.
So how do you stop an earworm from nagging you all day long?
Some people swear by the use of “eraser tunes.” Like swallowing a spider to catch a fly, one simply thinks of a catchier melody to drive out the annoying earworm.
Humming “there was an old lady…”
Of course, there’s always a risk that the new tune will lodge in your brain as a replacement earworm! Until science finds a de-worming cure for our ears, some of us may have to just keep humming along…
(Interstitial Theme Music)
Phil Stieg: Has music therapy played any role in the treatment of common issues like anxiety and depression?
Caitlin Hebb: Absolutely. It’s kind of where music therapy started, honestly, was looking at anxiety and depression. They had actually worked with post World War II, they were working with veterans. And it wasn’t actually a music therapist, it was musicians.
They were bringing in musicians and the nurses were using music because they found that it had this calming effect for veterans who were having more of a PTSD response. And then they were like, okay, we need people to be more trained in how to use music effectively. So that’s where kind of the field developed beyond.
Phil Stieg: Tell me a little bit why you think music is so strongly linked to our memories.
Caitlin Hebb: First and foremost, we think about music, it’s a pattern, right? And particularly Western music. It doesn’t matter who you are, really. If I was to go “da da, da da, da da da….”
Chants melody of “Twinkle Twinkle” with the last note missing.
You’re thinking “Daaaa” (last note of the melody), right?
And so it’s this kind of like, pattern that we hear over and over again, and our brain likes that. And so I think just the way that music activates our brain, the structures that it engages, how it changes our brain, there’s actually recent science coming out that talks about the actual music memory part of our brain is different than other areas. So they find that that actually could potentially be preserved with patients who have dementia and Alzheimer’s, which is why we see this profound result.
Phil Stieg: Have you ever had the experience where you walk in and everyone said, gosh, we just can’t get any reaction from this person. They’re aphasic. And you walk in and you hum a tune and boom, all of a sudden the light goes on. That AHA moment. Have you experienced that?
Caitlin Hebb: Absolutely. And those patients then will look at me like, you stay here or you work with me every day. Those are those patients we say, we’re going to do a co-treatment because then we do a little bit of music, and then the speech therapist, it gives them the door as well.
Phil Stieg: You walk in, somebody can’t talk. It would seem to me that given your field now, everybody would try a little bit of diverse music to see whether you got a reaction. So, is that happening?
Caitlin Hebb: I think it’s becoming more common. I’ve heard physicians walk into a room and they say, oh, could you sing Happy Birthday? And they’ll start to get the patient going. So I think there’s a trend that it’s becoming more understanding that music has this effect. I still think we have a lot of room to go as far as people recruiting it sooner than later.
It used to be it was this last resort, we can’t do anything, maybe music will work. And so now I think it’s more of a first. Okay, we should use music here.
Phil Stieg: Good to hear. Good to hear. So where can our listeners go to find out a little bit more about NMT and whether it would be applicable to their disorder? Is there a website?
Caitlin Hebb: Yeah, you can go on the Neurologic Music Therapy Academy’s website. That has a list of providers and they break it up very nicely in demographically where they’re located. So you can reach out to NMTs. Either way if you reach out to one NMT, they probably would be able to help you find someone who may be in your area.
Phil Stieg: Caitlin, I appreciate you taking the time to help me and the audience learn how music is used and can be used to induce brain plasticity and our recovery from speech disorders, motor disorders, sensory disorders, coordination and gait disorders. But more importantly, in cognitive and emotional disorders, which are so common in our society today.
Thank you so much for taking the time to be with us.
Caitlin Hebb: Thank you for having me.