Ep 69: Music and Mind Series – Part 3 with Connie Tomaino

How does someone with a movement disorder that effects executive functioning suddenly move to music with a dance tempo?  Concetta M. Tomaino, Executive Director and Co-founder of the Institute for Music and Neurologic Function, and long-time collaborator with famed British neurologist Oliver Sacks, explores the power of music to reach those with dementia and other neurologic conditions. Tomaino dives into the research with host, Meryl Comer on ways to use music to awaken cognitive reserve in our loved ones deep into late-stage Alzheimer’s disease.  You won’t want to miss this episode in BrainStorm’s six-part series that showcases researchers & clinicians featured in Renee Fleming’s anthology Music and Mind: Harnessing the Arts for Health. 

Support for BrainStorm by UsAgainstAlzheimer’s is provided by Biogen and Genentech. 

Transcript

Connie Tomaino (00:00):

I've had patients who after a stroke were using a cane because they shuffle the injured side. They weren't paralyzed but had a Parsis that weakened the affected side and made it very difficult for them to move. But if I played a piece of music that had a dance tempo to it, they would automatically start lifting the affected lake to step in time.

Welcome (00:22):

Welcome to BrainStorm by UsAgainstAlzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder, 24-year caregiver and Emmy Award-winning journalist and the author of the New York Times Bestseller, Slow Dancing With a Stranger.

Meryl Comer (00:39):

This is Brainstorm and I'm Meryl Comer. Our guest today is Connie Timo, executive director and co-founder of the Institute for Music and Neurological Function. Her essay, music and memory, exploring the power of music to reach those with dementia and other neurologic conditions can be found in Renee Fleming's new anthology. Music and Mind. I asked her what she meant when she wrote that. For people with cognitive impairment thinking gets in the way of doing. I

Connie Tomaino (01:12):

Work a lot with people who've suffered stroke or people with movement disorders like Parkinson's disease. When somebody has a traumatic brain injury, something called executive function, the planning ahead, the thinking through steps can be very challenging. And even to think about putting their right foot in front of their left foot, they're alternating side to side. The type of instructions a physical therapist may give to them can be very complicated. And so in thinking, when they're thinking about what they need to do that inhibits them from actually moving because there's a slowness, there's a hesitation, there's an uncertainty. However, we have muscle memory of how to move. The question is, is how to get that organized. And because the rhythm of music provides a template in which we can move, it allows for that organization of the movement so the person doesn't have to think about it.

Connie Tomaino (02:06):

And that becomes the automatic response. It's like tapping the foot to music. We don't have to think about doing. So involuntary response, and if I can get the person to move without thinking about it, then they exercise all the components of movement they need for recovery. And then as they become more confident in those movements, then they can practice thinking about whether it is that they need to do on their own. But I want them to be comfortable in the act of moving so they don't have an accident so they don't fall and the music allows that to happen.

Meryl Comer (02:38):

It's also triggering muscle memory.

Connie Tomaino (02:40):

I've had patients who after a stroke were using a cane 'cause they shuffle the injured side, they won't paralyzed, but had a paralysis that weakened the affected side and made it very difficult for them to move. But if I played a piece of music that had a dance tempo to it, they would automatically start lifting the affected leg to step in time.

Meryl Comer (03:01):

The latest research reveals that the auditory system is critical. Tell us why loss of hearing is also an increased risk factor for dementia.

Connie Tomaino (03:11):

I'm not a basic neuroscientist, so in the auditory system is very complicated, but because the auditory system is really the first sensory system that develops in us, in fact, the auditory perception or beat perception is present in the fetus before it's born. It's a very integral basic process that we need to be able to understand the world around us when we're born. We need to understand the sound of our parents' voice and the meter of that sound, and we need to understand dangerous sounds from safe sounds. And so we need to make those associations very early on. It's a survival mechanism. And for that reason, the auditory system is very robust and very much connected to not only memories and acts of things we do, but also involuntary function like respiratory rate and heart rate. So we can actually influence those rates with auditory signals of music 'cause of the broadness in how those networks are connected.

Connie Tomaino (04:10):

The auditory system is very important. Now, if somebody starts losing their hearing, especially in older age, it's usually certain frequencies of sound. So maybe the higher pitches of sound and may be certain aspects of the continents and beginnings and the endings of words that may be hard to distinguish. But most people will still appreciate music unless they've totally lost frequencies that keep them from enjoying complex music. You know, like a symphony orchestra may be hard to understand. There's also situations, people who have frontal temple dementia, FTD, may also have damage in the auditory cortex where melody, where pitch of music is processed. So if somebody used to love music and now gets very agitated when their music is being played, it could be that they don't hear it anymore, that it just sounds like noise. So something to be aware of.

Meryl Comer (05:03):

Connie, I'd like to go back to your point that there are about 10,000 board certified music therapists in the us, but only seven to 13% work in geriatric care. My personal concern is that music therapy and long-term care facilities is too often used as a management tool to give the nursing aides a break and not engagement with the patients at a level that would elicit the kinds of responses you're talking about.

Connie Tomaino (05:29):

The challenge there is funding, and it's the recognition that music therapy by a music therapist is important and valuable, and the facilities and agencies that fund those facilities see the value not only to the individual residents that they care for, but also in the economic benefit to the agency. If that person is more engaged and less agitated, then they're going to do better and require less medication. Now there still needs to be research to justify all that, but colleagues and people who've observed this know it to be true. In fact, just recently, AARP and the Neuro Arts Blueprint funded an economic benefit study by KPMG was the organization that did the analysis and showed the cost benefit of enhancing music, targeted music therapy and music-based programs for people with dementia simply because of that impact that it could have financially. You probably know that most nursing homes, especially if they're Medicaid funded, have a capitated rate that barely covers basic needs. Even myself, after 45 years, even if I'm supported through a salary, those funds still need to be augmented by grants and by private donations to sustain the program long term. And so that's the challenge. It's both having the powers that be, whether it's government policy or insurance policies to recognize the cost benefit of music therapy for this population. It's advocates like yourself and others who speak out on behalf of people with Alzheimer's and dementia to say that they want this as a service and how important it is.

Support info (07:09):

Support for brainstorm by UsAgainstAlzheimer's comes from Biogen, driven by our commitment to patients and our strong business foundation. Biogen remains dedicated to furthering Alzheimer's disease research and treatment aiming to help address the unmet needs in this devastating condition with an emphasis on early stage disease.

Meryl Comer (07:29):

Connie, what advice do you give families whose loved ones are being cared for in a nursing facility? How can they use music to engage and sustain their loved one's? Quality of life?

Connie Tomaino (07:40):

I know from people who care for their loved one and when they visit is knowing that they've changed and that frustration of maybe not being recognized. And I think if you can put that aside in those moments and think that this is a person that you really care about, that you want to be connected to in those moments when you visit, to bring music, to sing with them, to share music. The wonderful thing now is with technology, we can bring off iPhones and iPads in our visits and put on a Frank Sinatra live at Paramount or Elvis Presley or whatever, and march it together. And especially if those were artists that this person or that you visited together went to concerts together, early rock and roll and Motown and Broadway shows or the symphonies, whatever you experience together, you can find it on YouTube, you can find it on the internet, share those videos together, sing along. You could bring the kids, your grandkids, whatever, to those moments too. And believe me, the person will be able to participate. And in those moments of shared engagement, there's often that sense of knowing that I talk about that sense of recognition in those shared experiences.

Meryl Comer (08:48):

Connie, why is Renee Fleming's anthology music in mind that brings together noted researchers, music therapists across the art spectrum important to the field?

Connie Tomaino (08:59):

Renee Fleming has done a brilliant job in bringing so many people together in this anthology that she's just produced music in mind. And even the reason why Oliver and I started the institute years ago is that people are passionate about these topics. Everybody's working in their own area and many times we don't get a chance to share knowledge with each other to advance the clinical or therapeutic uses of music. There's so many people invested in this topic from very diverse areas and in anthology like this brings it together so the public has a way of appreciating how much work is being done in music and health, how important the work is that we're not just making it up. There is research that shows the efficacy that there are important people in important places who believe that this is worthwhile and needs support. And it's only when you see the volume of this information that you start to take notice of the importance of it. I would hope that enough important people read this and say, we have to do something, now's the time because music is one of those art forms that engages every part of the brain as well as emotional responses in a very deep level that it becomes one of the strongest tools that we could possibly use for health and wellness.

Meryl Comer (10:19):

Can you share your personal playlist?

Connie Tomaino (10:22):

Mine is so diverse. <laugh>, I don't know if I have one. I'm also professional trumpet player, so besides playing those other instruments, I play with different wind ensembles and in concerts. So I have a whole line of different type trumpet works in that could be mild Davis to Clifford Brown, to Marie Andre, or somebody really classical, but then this pop music that I would listen to Kenny Rankin and sort of the mellow type rock. Yeah, it's so much.

Meryl Comer (10:48):

I think the advice is we should all be writing down our personalized playlist for our kids.

Connie Tomaino (10:54):

Absolutely. The music that helps you go to sleep, that relaxes you, the music that energizes you, the music you want to hear when you wake up in the morning, the music you want to go to sleep with. The music, you absolutely never want to hear the music that you hate. I could think of certain songs I wouldn't want to hear.

Meryl Comer (11:10):

Thank you so much. Our guest today is Connie Tono, executive director and co-founder of the Institute for Music and Neurological Function. Her essay, music and memory, exploring the power of music to reach those with dementia and other neurologic conditions can be found in Renee Fleming's new anthology. Music in mind. That's it for this edition. I'm Meryl Comer. Thank you for brainstorming with us on brainstorm. We interview top experts in dementia research and brain health, but we know you are the experts on the Alzheimer's journey, which is why we invite your participation in our a-list. By joining and taking periodic surveys, you're helping inform healthcare providers, policy makers, and other leaders in the field about your experience and what matters most to you. It only takes a few minutes of your time. Join the A-list and see how it feels to be heard.

Closing (12:13):

Support for BrainStorm by UsAgainstAlzheimer's comes from Genentech. Genentech is prepared to ask tough questions To help tackle the root causes of systemic inequities in healthcare. Subscribe to brainstorm on your favorite podcast platform and join us on the first and third Tuesday of every month.