Music

Concetta Tomaino and the Healing Power of Music

Concetta Tomaino with her late colleague Dr. Oliver Sacks, to whom Dustin Hoffman presented the Music Has Power award in 2006.

Music! We know it can stimulate, excite, soothe, transport . . . . indeed, it sometimes sparks emotion so pleasurable that it actually sends chills down the spine. (Like sex, cocaine other abused drugs, and food, music triggers the area of the brain that releases dopamine, a neurotransmitter associated with feelings of pleasure and reward.)

But who knew that music has the power to help stimulate the memory of patients with Alzheimer’s disease; help Parkinson’s patients learn to walk again; help restore speech to a patient who has had a stroke; help a child with autism learn to socialize and speak for the first time; reduce blood pressure; and reduce severe anxiety in pre- and post-surgery patients?

Back in 1978, when Concetta Tomaino was doing her clinical internship as a music therapist at a nursing home in Brooklyn, practically no scientist was doing evidence-based research on using music to heal. She would be one of the first.

“At the time, all that people thought about music therapy was that it could be used to engage people, to help them socialize,” she says. “I was working with people with end-stage Alzheimer’s disease. They were non-responsive or very agitated and not connected to anything in their environment. And yet, when familiar music was played to them, they showed recognition – some sang the words Working with these people demonstrated to me that there was something about music that connected to people who seemed to have no cognitive function left. That’s what started me on this quest to understand how music can access and preserve function in people who seem to have lost it.”

Her quest continued two years later, when she became staff music therapist at Beth Abraham Hospital (now Beth Abraham Health Services), a nursing home and rehabilitation center in the Bronx. At the time, she says, the theory in brain science was that once the brain was damaged, it was damaged forever; whatever function was lost was lost forever. But as she was working with patients with Alzheimer’s or some other form of dementia, as well as those who had suffered traumatic brain injury, “they were minimally responsive, but with music therapy they started speaking and coming back to life and connecting, showing that functionality was still present.”

The staff neurologist at Beth Abraham was the renowned neurologist Oliver Sacks (he died last year). By 1980 he had published Awakenings, his book recounting the awakening, through the use of the drug L-DOPA, of a group of patients who had been frozen in immobility for 50-odd years, since they had contracted sleeping sickness in 1918. When he came to Beth Abraham he observed that music allowed some motor function in people who couldn’t move on their own.

So Dr. Tomaino came to him and said, “Well, if that’s so, what about people with memory loss? How is it possible for somebody who has no memory to process sound can recall information connected to the music?”

The two formed a team with a mission to explore the healing power of music. Dr. Sacks sent his pateints with traumatic brain injuries, dementia, stroke, and Parkinsons’ disease to Dr. Tomaino, and she would work intensively with them (her method is described below). He would observe their responses, and then the two would discuss what they thought was going on. “We knew we were changing people,” Dr. Tomaino says. “We knew that music was accessing and preserving function, and stimulating and organizing it in a way that nothing else did. But the scientists in the early ’80s couldn’t help us at all.”

Fast-forward a few years. “By the mid-’80s we were starting to get the interest of some scientific thought. By the late ’80s and early ’90s there was some research in the area of neuroplasticity, showing how new dendrites could be generated in nerve cells and how the new connections could be excited to re-stimulate things like auditory processing. At that point we began thinking that maybe we could study this in a more formalized way.”

And so, in 1995, with the support of the Beth Abraham board of directors, they formed the Institute for Music and Neurologic Function, a nonprofit organization whose programs (both in-patient and outpatient) use music therapy to assist the “awakening and healing” of individuals with a wide range of neurological conditions. including strokes, trauma, dementia, and Alzheimer’s and Parkinson’s diseases. The IMNF is also a research organization set up to be a forum highlighting the potential of music therapy across a variety of clinical applications.

RELATED: Movies: ‘The Lady in Number 6’: Music Saved My Life”

 

 

This video by the Institute of Music and Neurologic Function illustrates how patients respond to music therapy.

Dr. Tomaino’s duties are now mostly administrative, but she has worked with thousands of patients over her 38-year career in music therapy. Asked for a snapshot of how she works, she says, “I either have my accordion with me, or, if I’m seeing someone for the first time, I may also have an iPad with lots of music on it.

“Say I’m working with somebody with Alzheimer’s disease. I want to explore their ability to recognize and respond to music that they would know. [For maximum emotional arousal, it’s important to choose the particular music the patient likes. “Fortunately, these days people make playlists,” Dr. Tomaino remarks.]

“We have an intake form we send to the family members and caregivers before the first visit, so we know the person’s music background and musical taste. So, based on that, I would explore how they would respond to the music. Can they follow the rhythm? That gives me an indication of a level of auditory processing. Do they recognize tonality? That gives me some indication of their memory capacity. Are they able to express themselves emotionally—are they emotionally quiet, or do they have a scope of emotions that they show? All of those responses give me an indication of a level of function that I can work with. In all the situations, I am actively engaging the patient to respond, not just having them passively listen.  I ask them how it felt  . . .  I’m trying to engage them in making music with me.

“If somebody seems to be cognitively damaged and we want to see if that person is aware, we use novel sounds to see if we can trigger any response at all, like a reflex or startle response.  Somebody with severe brain damage is not going to recover, but if it’s someone who had a recent traumatic brain injury who is minimally responsive, I’ve seen such a patient wake up and regain consciousness by having familiar music played at the bedside.

“Seeing somebody wake up and talk is amazing; even doctors know that the auditory system is connected to deep brain mechanisms, so we are able to stimulate arousal at the end of consciousness  because of the emotionally charged sound.”

With Parkinson’s patients who have lost their ability to speak, a music therapist will encourage humming, to prevent atrophy of the vocal folds. To help Parkinson’s patients improve their gait—since they may  not perceive the beat the way the rest of us do—the MT will manipulate the beat until the patient can feel the rhythm.

Dr. Tomaino’s  late colleague Dr. Oliver Sacks had made a series of videos showing how music therapy can help heal people damaged with dementia or brain injury, Perhaps the most compelling  is the one in which the charming doctor explained how he used music as an intensive learning tool for those who have aphasia (loss of the ability to speak) after a stroke—for people with aphasia can nevertheless sing. It may take 70 or 80 hours of effort, “but,” he acknowledges, “to regain one’s language, one would give one’s soul.”

Thirty-eight years after she began practicing as a music therapist, Concetta Tomaino has seen the expansion of the use of music therapy into hospitals, nursing homes, rehab centers, and schools around the country. She has also seen the field of research into the use of music for healing become so fruitful that, asked for some research links (here’s just one of them), she declares, “There’s so much research now, I get about five reports on my desk every day.”

RELATED: Poetry Sunday: Words and Music,” by Laura Feigenbaum

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  • Dina May 21, 2017 at 11:24 am

    Heike–thank you so much for sharing so openly . . .my favorite part was the end of your podcast, where your joy and gladness just bubbled over :). What a joyous relief it must be, to be free of the weight of unforgiveness. I’m still working on it . . . but I’m not giving up :)sp;sn;&nb&p;|&nbspb 

    Reply
  • Heather Turi July 25, 2016 at 7:18 am

    What an inspiring and educational article about the healing power of music!

    Reply
  • Claudia Harkins July 12, 2016 at 3:05 pm

    Thanks to Dr. Tomaino and Dr. Sacks for this exciting research which is improving and changing the lives for so many people affected with Alzheimer’s disease and other forms of brain-related illnesses.

    Reply
  • Robert Harkins July 11, 2016 at 3:42 pm

    I was unaware of this line of investigation, results are indeed interesting in patients who appear lost.

    Reply
  • Susanna Gaertner July 11, 2016 at 11:21 am

    Another deeply researched and timely article on a topic that is now and will be increasingly relevant to the Boomers as they age into cognitive challenges.
    Well done, Deb!

    Reply
  • Susanna Gaertner July 11, 2016 at 11:20 am

    Another deeply researched and timely article on a topic that is now and will be increasingly relevant to the baby boomers as they age into cognitive challenges.
    Well done, Deb!

    Reply