Parkinson’s Disease and Music: Bringing Together Community with a Therapy for All
Neurology residency affords the trainee an opportunity to help take care of people with a wide variety of neurological conditions and life circumstances. One aspect of the Movement Disorder subspecialty that attracted me during my training was the opportunity it affords to establish long-lasting relationships with people living with Parkinson’s disease and their families and caregivers. I’ve always been struck how this syndrome (a more accurate moniker than “disease,” given its variable causes and variety of signs and symptoms experienced amongst individuals) entered the lives of people with such diverse backgrounds and interests, and over the past seventeen years of practice in this realm I continue to learn from my patients just as I hope they’ve learned from me. When Eli Pollard asked me to contribute to this blog, I thought it might be an opportunity explore a connection I’ve had to the PD community via a passion of equal interest to me as neuroscience, the study of the basal ganglia, and the treatment of Parkinson’s: Music. Many of you already realize music’s capacity as a therapeutic (and joyful!) tool and, of equal importance, as a thread uniting communities of those affected by PD. For these reasons, I hope you will find this blog post of interest.
The basal ganglia network that begins to break down in the parkinsonian syndrome is not only critical in facilitating the output of smooth, coordinated movement, but intimately depends on the input it receives from our senses – vision and hearing in particular. I recall early in my training while seeing patients with Dr. Stanley Fahn in his clinic the advice he would give to some of those we saw with PD: “Consider square dancing!” This unorthodox form of movement therapy depends on auditory cues provided by both changes in melody and rhythm as well as the verbal cues that are given. This was my first introduction to the concept that the right kind of sensory input could have a potential therapeutic impact on improving motor (ie mobility) output for those with PD. There have been numerous studies over the past 20+ years that have supported this concept, as varied as using specialized glasses with visual field cues 1,2 and laser light cues 3 to improve walking, and forms of music and dance therapy to facilitate mobility.
The Dance for PD organization, founded by David Leventhal and Olie Westheimer in Brooklyn, New York (and successfully expanding with chapters throughout the world) has been a wonderful example of merging something that combines the joy of music and dance with evidence-based outcomes of improvement 4,5 (and see WPC blog July 3, 2017). A few years ago I was invited a to speak on the topic of “Music and the Brain” at a Dance for PD gathering in Portland where I live. This provided me the motivation to research the related literature in this field, especially as it might pertain to PD. While reviewing the topic, I was reminded how music activates nearly every region of the brain, from the cerebellum’s processing of rhythm, tempo and meter, to the hippocampal processing of musical memory; from activation of the
Alban Gerhardt and I speaking on music and the brain.
amygdala with an initial emotional response to music, to activation of the nucleus accumbens with the pleasure of listening to music; from the temporal and occipital cortices involvement in listening to and reading music, to the frontal and parietal cortices involvement in performing music; and of course the basal ganglia, the structure in the brain hit hardest in PD, which processes of many of these functions. One fascinating paper I reviewed related the effect listening to music has on the release of dopamine, the chemical messenger that becomes most depleted with PD. A key finding of this study by Valerie Salimpoor and colleagues 6 was that the intense pleasure experienced in response to music leads to dopamine release in the striatal system - the same effect being sought when someone with PD takes dopamine replacement medications. The evidence for the benefits of dance for those with PD is clear as well. There are a number of studies that support this, most notably by Madeleine Hackney, Gammon Earhart and colleagues. 7-9 Tango appears to lead the list of dance types that lead to sustained improvement in mobility and balance, however other effective dance styles have been noted.
Alban Gerhardt playing the cello at the Dance for PD event.
The true entertainment of the gathering that day was a performance by the Oregon Symphony’s Artist-In-Residence, Alban Gerhardt, a world-class cellist who performed Bach’s “Prélude” Cello Suite No. 1 in G Major. Listening to Alban play while watching our local community of participants with PD move in synchronicity to the sublime melody and rhythm of this masterpiece, their “bradykinesia” (slow movement) and muscle stiffness seemingly melting away, brought into focus the potential that music can afford those who’s inherent rhythmicity of movement has begun to break down. I would highly encourage anyone reading this who lives with PD to seek out a local Dance for PD chapter – or, if there is not one, start one yourself!
I play guitar (and attempt to sing) and have had the pleasure of getting to perform music myself in the spirit of spreading awareness about Parkinson’s and bringing this community together to have fun, further strengthening the bonds I’ve shared with those living with PD. Here are some memorable occasions:
Rob Barteletti and I performing at Shakers Ball.
Rob Barteletti, a talented singer/songwriter I helped take care of, organized the annual “Shakers Ball” in Portland for many years, bringing together regional rock’n’roll bands to perform and raise awareness of PD in our community. It was always Rob’s own music and performances that served as the greatest inspiration at this event, and I feel lucky to have gotten to play with him at these gatherings.
Brian Grant and Hadley Ferguson
A journey to Montana in 2011 to play at Missoula’s historic Wilma Theater with accomplished musician Bart Ferguson and his brother John, husband of another individual I’ve helped take care of named Hadley Ferguson, was equally inspirational. I’m lucky to count Hadley and her extended Portland-based family as friends. That trip was made all the more memorable in the company of the Brian Grant Foundation team in their formative years, for this “Summit for Parkinson’s” event which brought this community together to celebrate those living with PD, highlighted by Hadley’s incredible visual artistic talents on display. John and I chose a few select songs to cover, including one of Hadley’s favorites, Sugar Mountain – Neil Young’s lyrics (with some added personalized verse of my own) became ever more poignant when sung to a gathering of people living with PD.
Ray Chaudhuri and I at the 2014 MDS Congress.
And, this part of my blog would not be complete without mentioning the distinct honor of sitting in with the infamous Brainstorm during the opening ceremonies of the Movement Disorder Society’s 2014 International Congress in Stockholm (thanks Ray!).
When the World Parkinson Congress convened in Portland, Oregon last autumn, I had the privilege to co-chair the local organizing committee. Along with helping to oversee numerous local logistics, our committee discussed various ways in which we might bring music into this most unique event – and ultimately highlight the talents that people with PD could show off to their peers, friends, caregivers, family members, (and, in some cases, their doctors). A “Music and Movement” evening of performance was organized, emceed with inimitable style by David Sangster, displaying some of his own musical prowess. For those of you who were able to attend that evening, you may have gotten to see Joe D’Urso close out the show, representing the New Jersey-based Light of Day Foundation (who’s self-proclaimed mission is to “utilize the power of music to raise money and awareness in its continuing battle to defeat Parkinson’s disease.” Joe brought his Asbury Park rock’n’roll energy in earnest, easily filling the shoes of Light of Day’s perennial surprise guest Bruce Springsteen, who sat out this particular engagement (his loss!). The true inspiration for me that evening however were the performances given by those living with PD. Tom Isaac’s singing performance (reprised at the WPC closing ceremony) was unforgettable.
Forging Resilience by Hadley Ferguson
When Eli asked if I wanted to contribute to that evening, I gladly accepted. Hadley Ferguson had made the journey down to Portland – many of you likely admired her unbelievably beautiful, intricate and emotionally moving Forging Resilience tree on display at the Congress. I asked Hadley if she’d come that evening, and once she confirmed I was inspired to reprise Sugar Mountain. When I arrived early at the event’s location to tune up my guitar, I befriended a young woman there who was also warming up and going over the songs she planned to perform. For any of you who’ve met Meg Bernard, you know what a gift she has as a singer/songwriter/guitarist – and amazingly so, in spite of the unique challenges related to her advanced form of Parkinson’s.
Meg Bernard and I performing at WPC 2016.
Meg and I started to chat and I sheepishly asked her if she’d consider backing up my mediocre singing voice, which she happily agreed to (thank you Meg!). Along with Hadley’s request, I performed “Fly”, a song I wrote 15 years ago after a flight I was scheduled to be on crashed in the Himalayas. I wrote the song to commemorate the lives of all the trekkers who died that day, but singing it this time with Meg’s outstanding vocals breathed new purpose meant for all to share. After that, Meg further dazzled the audience with a performance of her beautifully composed songs. It was a magical evening, inspired by the creative energies of a global PD community. Hopefully we will continue this tradition in Kyoto in 2019 and beyond!
I’ll close this blog by quoting the late Tom Petty, who said “Music is probably the only real magic I have encountered in my life. There’s not some trick involved with it. It’s pure and it’s real. It moves, it heals, it communicates and does all these incredible things.” So for all of you who already find a way to incorporate music into your lives every day through listening, dance, or playing – including your voice – carry on! And for any of you who have not yet found a way to do so, carpe diem!
References:
1. Ahn D et al. Smart Gait-Aid Glasses for Parkinson’s Disease Patients. IEEE Trans Biomed Eng 64(10), 2394-2402 (2017).
2. McAuley JH et al. A preliminary investigation of a novel design of visual cue glasses that aid gait in Parkinson’s disease. Clinical Rehabilitation 23, 687-95 (2009).
3. Donovan S et al. Laserlight cues for gait freezing in Parkinson’s disease: An open-label study. Parkinsonism and Related Disorders 17, 240-5 (2011).
4. Shanahan J et al. Dance for People with Parkinson Disease: What Is the Evidence Telling Us? Arch of Physical Medicine and Rehab. 96, 141-53 (2015).
5. Sharp K et al. Dance as an intervention for people with Parkinson’s disease: A systematic review and meta-analysis. 47, 445-56 (2014).
6. Salimpoor VN et al. Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nature Neuroscience 14 (2), 257-62 (2011).
7. Hackney M et al. Effects of Dance on Gait and Balance in Parkinson’s Disease: A Comparison of Partnered and Nonpartnered Dance Movement. Neurorehabil Neural Repair 24(4), 384-92 (2010).
8. Duncan R et al. Randomized Controlled Trial of Community-Based Dancing to Modify Disease Progression in Parkinson Disease. Neurorehabil Neural Repair 26(2), 132-43 (2012).
9. Shanahan J et al. Dancing for Parkinson Disease: A Randomized trial of Irish Set Dancing With Usual Care. Arch Phys Med Rehabil 98 (9), 1744-51 (2017).
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Matthew Brodsky, MD served as co-chair of the Local Organizing Committee and a presenter in Portland, Oregon for the Fourth World Parkinson Congress. He is an associate professor of neurology at Oregon Health & Science University, a key member of OHSU’s Parkinson Center and Movement Disorders Program and medical director of OHSU’s Deep Brain Stimulation Program.
Ideas and opinions expressed in this post reflect that of the authors solely. They do not reflect the opinions or positions of the World Parkinson Coalition®