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Singing for Speech: Restoring Stroke Victim's Voices

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PORTLAND, Oreg. (Ivanhoe Newswire) - It steals your speech, scrambles your thoughts and robs you of your ability to move. Stroke is the third leading cause of death in America. It's the number one cause of disability. Now, victims are turning to song to get their voices back.

These different patients all have the same story.

"I woke up and I was numb on one side," Barbara Pope told Ivanhoe.

"I cannot move my right arm," Lee Jordan told Ivanhoe.

"It's all in there, it's in there, but I can't have it outlet," Phil Liu told Ivanhoe.

Like many stroke victims, Phil Liu woke up and couldn't speak.

"The only word I could say was yes," Liu said.

 Music got him talking again. Patients at the Oregon Stroke Center come together each week to sing.

New research suggests singing or playing music, maybe even just hearing it, helps rewire the brain after a stroke.

"Music is represented more in the right side of the brain in most people, and language more on the left side," Helmi Lutsep, MD, Professor of Neurology at the Oregon Health & Science University, told Ivanhoe.

Doctors are trying to use music to move language skills from the left, to the right side of the brain.

"Maybe we can allow language also to, um, sort of rewire itself," Dr. Lutsep said.

It may never be too late to start.

"We've done trials with people as late as 17 years out from their stroke and they still showed improvement," Dr. Lutsep explained.

New studies out of Temple University found that music not only affects a person's motor abilities, but also lowered stroke patients' blood pressure, heart rate, and level of anxiety.

RESEARCH SUMMARY

BACKGROUND:  A stroke happens when blood flow to a part of the brain stops, sometimes called a "brain attack."  If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen.  Brain cells can die, causing permanent damage. There are two major types of stroke: ischemic stroke and hemorrhagic stroke.  Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. It can happen when a clot is formed in an artery that is already narrow, called a thrombotic stroke.  It can also happen when a clot breaks off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain, called an embolic stroke.  Ischemic strokes can be a result of clogged arteries.  A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain.  (Source:http://www.ncbi.nlm.nih.gov)

STROKE RISK FACTORS:  High blood pressure is the number one risk factor for strokes.  Other risk factors can include: atrial fibrillation, family history of stroke, diabetes, high cholesterol, increasing age (especially after age 55), and race (black people are more likely to die of a stroke).  People who have heart disease, poor blood flow in their legs caused by narrow arteries, are overweight, drink heavily, eat too much fat and salt, smoke, and intake cocaine or other illegal drugs are more likely to have a stroke.  Also, women who are on birth control pills have an increased risk as well.  (Source: http://www.ncbi.nlm.nih.gov)

TREATMENT:  A stroke is a medical emergency; immediate treatment will save lives and reduce disability.  Patients should be at the hospital within three hours after they notice symptoms.  Clot-busting drugs may be used if the stroke is caused by a blood clot.  It will help break up the blood clot and helps bring back blood flow to the damaged area, but not everyone can get this type of medicine.   A patient must be seen within three hours of when they notice symptoms first started.  If the stroke is caused by bleeding, then clot-busting drugs can cause more bleeding.  Other treatments will depend on the cause of the stroke.  For example, blood thinners, like warfarin, can be used to treat strokes due to blood clots.  (Source:http://www.ncbi.nlm.nih.gov)

NEW TECHNOLOGY:  A new way to treat stroke patients is through music therapy.  Music therapy is the therapeutic use of music to help patients physically and psychologically recover form medical conditions, including strokes.  Doctors often recommend it along with physical therapy and occupational therapy.  It has been around for thousands of years, but it wasn't until 1950 that it was recognized in the U.S. with the formation of the American Music Therapy Association (AMTA).  According to Al Bumanis, director of communications for the AMTA, music therapy helps stroke patients recover by using music, specifically rhythm, to relearn and the singing techniques can be used to improve speech.  If stroke patients are having trouble communicating clearly, music can help them communicate their mood and ease their frustration.  Drums are particularly effective in helping stroke patients communicate because they can learn patterns to help them communicate.  Music therapy can also help a stroke patient regain control over their muscles and regain lost skills, like walking, by matching the tempo to where the patient is and then doctors will gradually increase it.  (Source:http://www.musictherapy.org 

INTERVIEW

Helmi Lutsep, MD, Professor and Vice Chair, Department of Neurology, at Oregon Health and Science University, talks about musical therapy for stroke survivors.

Is it ever too late to recover from a stroke?

Dr. Lutsep:  It is one of the things that has really changed about strokes. We do not think it is ever too late to recover from stroke anymore. We have conducted trials with people who had their stroke 17 years ago and they still showed improvement. So, I think that the brain has more capacity for plasticity than we previously thought.

We just came from a music group and a lot of it was camaraderie. Is that a big part of the music therapy? 

Dr. Lutsep:  We do not know exactly how music therapy works. There are all kinds of theories; it is probably helpful for language recovery, but I think that the support that people get from each other is a huge part of it. Especially since they do not necessarily meet other people just like them if they are younger patients. Support groups may not have as many young patients in them; therefore, I think it is a fantastic social outlet.

Is this something new or has it been around? 

Dr. Lutsep:  We have known for hundreds of years that people can sing when they can't talk after a stroke. It is remarkable sometimes.  For example, you ask somebody who is mute to sing happy birthday and suddenly they can produce words. We know this, but I think what we have not known is how to tap that. Now, there is more interest in actually using music to try to create some changes in the brain and allow people to speak better.

Why can music do that when other things cannot? 

Dr. Lutsep:  We think that one of the ways it works is that music is represented more in the right side of the brain and language more on the left side of the brain. So, if we can tap that area, maybe we can allow language to rewire itself. In many people, there is actual spread to the right hemisphere to allow people to talk better.

You see scans where images light up on certain parts of the brain; can you see lights in certain parts of the brain that didn't have it?

Dr. Lutsep:  Yes. We use techniques like functional MRI imaging. It will show that in a person who has had a stroke, affecting the left side of the brain where language usually sits, that the areas can expand further in the left side, but also to the other side of the brain to the right hemisphere.  We think that, with music, it might actually help do that since music lives on the right side as well.

What's the most extreme case you have seen music help?

Dr. Lutsep:  I would say the most extreme are the cases in which the patient really cannot say anything.  Then the therapist, or someone, starts singing with them and they start to be able to produce words for the first time.  It really gives them hope and gives their families hope that they may be able to talk again.   

Do you see people going from being desperate to having hope?

Dr. Lutsep:  Yes.  I would say they do have hope.  I should be clear that it doesn't mean that they can talk from then on; it is still a huge process and takes a lot of work to be able to talk as well as sing.  

Are you phil's doctor?

Dr. Lutsep: Yes I am. 

How have you seen music change him?

Dr. Lutsep:  One, he is able to communicate better. I don't know how much is from music and how much is from time and using language.  However, Phil is also becoming more social, more of a leader, and more interactive.  So it has been great.   

Do you have any numbers from studies?

Dr. Lutsep:  No, in fact the first real study of music is ongoing right now.  So people have been using it for therapy, but without really having the hard data it's hard to know how many people it might help. 

Is there a certain type of stroke, where this wouldn't help?

Dr. Lutsep:  Well, we are aiming at people who have a particularly hard time producing words.  Some people where the language is affected, they also can't understand language and that's harder because it's harder to be able to guide people when they don't really understand what is being asked of them.  So, it will help primarily those people who have a hard time producing words. 

FOR MORE INFORMATION, PLEASE CONTACT:

Todd Murphy
Senior Communications Specialist
OHSU Brain Institute
(503) 494-8231
murphyt@ohsu.edu

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