Thriving in harmony

Music therapy might help ease MS symptoms.

by Elizabeth Michaelson Monaghan

When Chuck Knight of Erie, Pennsylvania, participated in a research study for people with multiple sclerosis, he found himself listening to pre-recorded music while walking a half-mile every day for two weeks.

“The music was upbeat, almost like a marching band,” recalls Knight, chair of the National MS Society’s board of trustees in the Pennsylvania Keystone area. “I tried to match the beat with my walking [gait]. It helped me to keep going at a consistent pace.”

The experience prompted him to incorporate tunes into his workout: “Now, I use my own music—older rock and pop—when I go to the gym and use the elliptical machine or bike,” explains Knight, who was diagnosed with MS in 2000. “The music helps with my energy because it diverts my attention from working out when it gets hard, especially toward the end.”

Music therapy techniques

Music therapy—the use of music to improve people’s physical, mental and emotional health and well-being—has a long history, but its modern growth as a practice and an established health care profession dates to the 1940s.

Music therapy is searched more than 33,000 times a month on Google.

In the last few decades, the development of neurological music therapy techniques has spurred the use of music therapy to “enhance neurological functions (e.g., walking, speech) in patients with conditions that affect the nervous system,” including MS, explains Francois Bethoux, MD. Dr. Bethoux is the medical director at Ohio’s Cleveland Clinic Arts and Medicine Institute; director of rehabilitation services at the Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research; and professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. There are several neurological music therapy techniques that people with MS may find helpful, according to Concetta M. Tomaino, the executive director and co-founder of the Institute for Music and Neurologic Function in Mount Vernon, New York. These include:

• Music composition and composition exercises to help improve attention and short-term memory.
• Familiar song lyrics to help with speech articulation and word finding.
• Therapeutic singing for clearer speech, breath control and posture.
• Playing instruments to boost range of motion, endurance and strength.

What the studies say
Dr. Bethoux and his colleague Lisa Gallagher recently reviewed several studies on the effects of various art therapies on people with MS. Despite a “need for more research,” Dr. Bethoux says that potential benefits of music therapy include improved “emotions and quality of life, coping, self-efficacy, energy, memory and movement.”

For instance, the Cleveland Clinic study Knight was enrolled in found that listening to specially designed music set to a tempo 10 percent faster than their comfortable cadence (number of steps per minute) helped some participants increase their walking speeds. Dr. Bethoux adds that with this technique, known as Rhythmic Auditory Stimulation, “we have also found that walking to music 20 minutes per day results in improved gait [walking] in some individuals.”

Music and music therapy could also help reduce pain and stress in people with MS, who may “report worsening of various symptoms [for example, tingling, pain, spasticity and fatigue] with stress,” Dr. Bethoux points out.

And as Knight discovered, music could help some people stick to their exercise plans. “[It] would be harder to stay motivated without it,” he notes.

What to expect at a session
“Although music therapy sessions are individualized, the therapist typically begins by assessing the patient for pain, anxiety, mood and current issues,” explains Gallagher, a board-certified music therapist and research program manager at the Cleveland Clinic Arts & Medicine Institute.

Next, the therapist and participant identify goals such as addressing emotional, physical or speech concerns, and “the therapist offers choices of interventions,” Gallagher says. These might include “singing, moving to music, songwriting, music-assisted relaxation, instrument playing, song choices and music listening. The session continues with the interventions.”

In general, the person’s preferences should inform the choice of music, Dr. Bethoux says. However, “depending on the goal to be achieved, certain characteristics may be sought in the music, such as a strong and steady beat for Rhythmic Auditory Stimulation.”

The session concludes with “the therapist once again assesses[ing] the current status of the patient. They may discuss plans for future sessions,” Dr. Bethoux says.

Why music therapy is helpful
“Music is enjoyed by most people, triggers emotions, can be linked to memories, promotes motivation and engagement, and activates many brain circuits in ways that we are just beginning to understand,” Dr. Bethoux says. It’s also “widely available—a person can continue to enjoy it outside of music therapy sessions.” He notes that anyone who is interested could benefit from music therapy, and that music can be adapted to the person’s situation, abilities and preferences.

Dr. Bethoux believes these benefits will increase with time: “I am convinced that further research will lead to the discovery of other benefits [of music therapy for people with MS] and to a better understanding of the mechanisms underlying the changes seen.”

Even without professional music therapy, listening to music might help lift a person’s mood or help them exercise longer.

What music therapy costs
After an initial assessment, music therapists typically charge from $75 to $125 per hour-long session, says Judy Simpson, a managed-health care professional and director of government relations at the American Music Therapy Association (AMTA) in Silver Spring, Maryland.

While it’s not covered by traditional Medicaid, “some states cover music therapy under Medicaid Waiver programs for certain patient populations, such as individuals with autism,” Simpson notes. Separately, “Medicare recognizes music therapy as a covered service but only when provided as part of a treatment team within health care facilities. At this time, music therapists cannot bill Medicare directly.”

If you have private insurance, a letter of medical necessity or a prescription from your doctor may help. Many music therapists will work with insurance companies to facilitate coverage and reimbursement. Patients can contact info@musictherapy.org with questions about insurance coverage, Simpson adds.

How to find a music therapist
The AMTA and the Certification Board for Music Therapists can help you find a music therapist near you, while the Academy of Neurologic Music Therapy maintains a list of music therapists with neurological music therapy training.

Elizabeth Michaelson Monaghan is a freelance writer and editor in New York.