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suetruckeypd-blog · 8 years

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In Oliver Sacks’ book Musicophilia, Sacks writes a chapter on how Music Therapy was used way back in the 1960s to improve the motor skills and gait of patients with Parkinson’s Disease.

Gait in Parkinson’ patients is the change in fluid movement in arms and legs. Some of the most common Gait symptoms in PD patients are:

Lack of heel strike—foot lands either flat or forefoot lands first

Inability to extend the knee and flex the ankle in terminal stance

Reduced or absent arm swing

Reduced speed and amplitude

This is referred to in Sacks’ book as a kinetic stutter. When we walk, our steps move to a rhythm, which is automatic, but in Parkinson’s, this flow is gone and patients are unable to fall into a rhythm.

In this chapter, Sacks discusses his time working at Beth Abraham Hospital in the Bronx. There, there were many strangely immobile, entranced-looking patients, sometimes in strange postures, absolutely motionless, frozen in a trance like state. This was in 1966, where there was no medication of any use on these patients for their immobility. But, all the nurses and staff knew that these patients could move on occasion, with an ease and grace that came to them when listening or playing music. Most PD patients can not initiate any form of movement, but many could catch and return a ball if it was thrown, and all of them responded in some way to music.

“Some of them could not initiate a single step but could be drawn into dancing and could dance fluidly. Some could scarcely utter a syllable; their voices, when they could speak, lacked tone, lacked force, were almost spectral. But these patients were able to sing on occasion, loudly and clearly, with full vocal force and a normal range of expressiveness and tone.”

Other patients could walk and talk but only in a jerky, broken way, unable to keep a steady tempo. With these patients, music could modulate the stream of movement or speech, giving them steadiness and control.

Music Therapy was not a profession in the 1960s. The first formal music therapy program was set up in 1944 at Michigan State University, and the National Association for Music Therapy was formed in 1950. But music therapy remained, for the next quarter of a century, scarcely recognized.

While the power of music has been known for millennia, the idea of formal music therapy arose only during the First and Second World Wars, when large numbers of wounded soldiers were gathered in veterans hospitals, and it was found that their pain and misery and even, seemingly, some of their physiological responses could be improved by music. Doctors and nurses in many veterans hospitals started to invite musicians to come and play for their patients, and musicians were only too happy to bring music to the dreadful wards of the wounded.

Parkinson’s is often called a “movement disorder”, though when it is severe it is not only movement that is affected, but the flow of perception, thought, and feeling as well. The disorder of flow can take many forms; sometimes, as the term “kinetic stutter” implies, there is not a smooth flow of movement but brokenness, jerkiness, starts and stops instead. Parkinson’s stutter can respond well to the rhythm and flow of music. But it has to be the right kind of music—and the right kind is unique for every patient.

Sacks discusses how music has helped some of his Parkinson’s patient take more control of their bodies. One of his patients he said, “One minute I would see her compressed, clenched, and blocked, the next minute, if we played music for her, all of this would disappear, replaced by a blissful ease and flow of movement. She would smilingly “conduct” the music, or rise and dance to it. But it was necessary—for her—that the music be legato. Anything staccato, percussive music might have a bizarre countereffect, causing her to jump and jerk helplessly with the beat, like a marionette.”

“In general, the “right” music for PD patients is not only legato, but has a well-defined rhythm. If the rhythm is too loud, dominating, or intrusive, patients may find themselves helplessly driven by it. The power of music on PD is not, however, dependent on familiarity, or even enjoyment.”

Another one of Sacks’ patients, a former music teacher, said she needed music. She said that she had become “graceless” with PD. She had lost her former naturalness and musicality of movement. But when she found herself stuck or frozen, even the imagining of music might restore the power of action to her. As she put it, she could “dance out of the frame,” and move freely and gracefully.

“It was like suddenly remembering myself, my own living tune.”

Equally dramatic, was her ability to easily and automatically walk with another person, falling into their rhythm, their tempo, sharing their kinetic melody, but the moment they stopped, she would stop, too.

This power of music was invaluable with another patient, whose movements were too fast on the right side of his body and too slow on the left side. Only when he sat down and played the piano could he bring his two hands together in unison.

The movements and perceptions of people with PD are often too slow, though they may not be aware of this—they notice it only when they compare them-selves to clocks, or to other people. But if music is present, its tempo and speed take precedence over the PD and allow patients to return, while the music lasts, to their own rate of moving, that which was natural for them before their illness.

Reading this chapter was very interesting. I got some background on when Music Therapy started and how it was used in the early to mid 1900s. I also was able, through Sacks’ memories, get first-hand encounters of how PD patients acted with and without the stimulus of music. It was interesting to read about how music affects each patient differently. Where as one patient must have music playing at all times to continue their steady movements, others need only think of a song and they are able to walk as if they were never diagnosed with PD. I also found it very interesting that the type of music is very unique to each patient, but must be a legato tempo. Also interesting was the fact that PD patients can not initiate most movement, but can react quickly and on the spot if a stimulus, such as a ball thrown at them, is entered into the equation.

From here I would like to search for more information about how Music Therapy is used now for PD patients and search for some studies and their conclusions.

Source

Musicophilia by Oliver Sacks

http://www.art-13.ru/sites/default/files/musicophilia.pdf

#musicophilia #music #music therapy #parkinson's disease #gait #oliver sacks #stimiulus #legato

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