I just wanted to send a hearty thank-you to Newzpool and to my Spot.us community supporters for funding the pitch. Your vote of confidence was an invaluable show of support to me for spending a lot of time on this slightly off-the-beaten-path idea. I'm working very hard to come up with a crackerjack piece, and now have a wealth of reporting material to draw from -- thanks to you.
Best wishes,
--Andrew
Posted by Andrew Rosenblum on 07/09/09I had an email message from music therapist Andrew Sammons, who wanted to make clear that music therapists do not propose that they can truly cure diseases like Alzheimer's, which have no known cure. Rather, music therapy can reduce the symptoms, and make the person feel better, at least temporarily. And in some cases, as with melodic intonation therapy for strokes, the therapeutic exercise can help re-build damaged brain function.
But it's certainly not a cure-all.
Here is Andrew Sammons in his own words:
"The efficacy of MT treatment should be measured by the observable benefits to the patient. For instance, an elderly patient with Alzheimer's disease may exhibit wandering behaviors. The MT can treat this person by providing musical stimuli that engages the patient in a meaningful and engaging activity reducing the wandering behavior. "
"The lofty notion that MT will 'cure' neurological disorders and/or brain degeneration is not realistic. However, the MT is a valuable activity-based treatment (vs. medicine or surgical treatment) to this population and many others in the same way. This should make third party payers more keen on finding good MT's to provide this service in a consistent and enduring fashion."
Posted by Andrew Rosenblum on 06/18/09I had a fantastic visit to the Yountville Veteran's Home -- most of the material I want to save for the finished article, but as a tease I'll mention first that I was able to sit in on a session of "Movercise," in which the music therapist uses background music to focus the attention and stimulate the memories of Alzheimer's patients.
I was also able to observe a moving example of 1 on 1 therapy, in which the therapist sang and played guitar and harmonica with a Vietnam veteran suffering from schizophrenia, some dementia, and PTSD. For someone dealing with severe anxiety due to his illness and struggling with the traumatic memories of seing many women and children killed during the war, playing music for an audience, and multiple songs was a big deal. He previously was housed in a locked facility at Yountville, and refused roommates and wanted to be alone. This is what the shrinks call "self-isolating behavior."
Music becomes a way to draw an isolated person out, not by talking about his feelings, as a traditional therapy session might require, but by expressing them in music. And it is also a way to slowly bring himself back into the realm of human interaction without requiring a lot of conversation.
His MT tells me that he now will occasionally venture out of his room to perform as a Dylan-esque singer, guitarist, and harmonica-player for other residents -- for a short period. He now accepts living with a roommate. Also, singing allows him to speak much more clearly -- he has the schizophrenic symptom known colloquially as "word salad," in which he jumbles words and ideas together. It was striking to hear him sing -- while his words were not entirely clear, they were far more intelligible to my inexperienced ear than when he was speaking.
Posted by Andrew Rosenblum on 06/18/09The research suggests that the greatest chance to improve on the symptoms of autism comes during a brief window early childhood -- but because therapies tend to be labor-intensive and time-intensive, often requiring 1 on 1 work between a child and therapist, the costs can reach $70,000 per year.
Insurance companies, school districts, and the state-funded regional centers for persons with developmental disabilities will sometimes shoulder at least some of these costs -- however, they will sometimes also decline to pay for a service, seeking to shift the costs to one another, or back on the parents.
When this happens, having a young child diagnosed with autism poses parents with a Hobson's choice: skipping the therapy and missing the greatest opportunity for development in an autistic child, or paying thousands of dollars a month out of pocket, which can be financially ruinous. And the pressures are quite emotionally-draining. The divorce rate for parents of autistic children is estimated to be as high as 80% -- the National Autism Association is trying to establish the precise number.
What's all this got to do with music therapy? Even though your child might be getting real benefit from it, in most cases you're going to have to pay for it out of pocket. A kid typically isn't getting music therapy funding approved unless a parent happens to have CEO-level "gold-plated" insurance or is willing to battle the state regional center to have services funded.
"Our system does not work for the meek, the timid, or the afraid," says one San Rafael mother, who was able to get the regional center to fund music therapy for her severely autistic 13-year-old by twice appealing denials. "People that are afraid and that don't want to 'go against the man,' aren't going to get anything."
This mother, who I will quote by name in the final article, also points that the system is designed to wear down parents who are already heavily taxed by their childcare demands.
"The problem most parents of people with disabilities face is that they are so tapped-out and exhausted, that they feel even more exhausted with the kind of effort you need to get approval for something like music therapy."
And this adversarial system results not only in some kids not getting care they need, but appears to be perpetuating racial inequality. A UCSF study published in the fall found that people of color were 21-33% less likely to get services from the California regional centers than were whites. And members of minority groups who did get services tended to get significantly less in services, even controlling for severity of disability.
It all comes down to money. Critics of special education and disability services complain that spending tens of thousands a year on an autistic child is unfair when compared to the approximately $7,900 California spends per pupil in the school system. But this argument is callous toward people with autism, who are expected by these critics to sit at home, having never developed the basic skills to live or work in society. And it asks wealthy parents to take a huge financial hit, and low and middle income parents to face financial ruin, merely because their child happened to be born with autism. And that's about 1 out of 150 kids, according to the Center for Disease Control.
I thought these type of expensive medical services were why we had insurance. We can argue about whether the insurance should come from private insurance or the state general fund -- but ...Surely we shouldn't keep asking the parents of autistic children to keeping choosing between severe financial hardship and helping their kids develop basic daily skills that are necessary for life. Right?
Posted by Andrew Rosenblum on 06/11/09Just to let everyone know that I've arranged to visit and observe Yountville Veteran's Home next week, which has a large music therapy program. You can read more about the home here.
If anyone has questions that you'd like me to ask the therapists there, please send them to me at andrewrosenblum (at) gmail (dot) com.
Posted by Andrew Rosenblum on 06/11/09I've just about finished the first phase of information gathering about various cutting-edge music therapy techniques that are out there -- now begins the next phase of figuring out how available music therapy is to patients who need it. What I've learned so far is that like so much high-quality medical care in the U.S., the more money you have, the more likely you are to get the treatment you need.
For example, getting insurance companies to pay for music therapy to treat autism patients can be difficult. Part of that is that getting insurance to pay for autism treatment of any kind is tough. Insurance companies, school districts, and the government entities that allocate treatment to people with developmental disabilities known as regional centers typically try to foist responsiblity to pay on one another. It takes a lot of know-how, stick-to-it-iveness, and even a willingness to sue for parents of autistic children to avoid paying for services out of pocket.
One therapist I talked to who treats autistic children said he rarely gets any insurance reimbursement. Because his practice is based in Marin, he has an affluent client base -- and though he is vendorized by the Golden Gate regional center in San Francisco, he has never successfully gotten the center to pay for any music therapy.
Part of this reluctance to pay for music therapy for autistic children is due to discrimination against the condition as somehow unworthy of expensive help or treatment - but part of it is due to continued skepticism about the use of music as a medical treatment. As the therapist put it, "when people hear music, they think I'm just playing around with the kids on a rug," rather than engaging in heavily-researched techniques for helping autistic children develop social skills.
To counter the skepticism that music therapy is not really medical or scientific, the therapist was trained in a set of protocols known as "neurologic music therapy" (NMT) pioneered by a Colorado neurologist named Michael Thaut . NMT effectively formalizes various music therapy techniques as necessary for certain conditions, as undergirded by rigorous scientific experimentation.
Cathy Rivera, an NMT-trained therapist who just opened a practice in Monterey after moving from Austin, TX, said that the use of NMT techniques has allowed her to get Texas neurologists to request insurance-reimbursed music therapy for autistic children -- although she is uncertain whether she will be able to do the same here in the Bay Area. Rivera also said that high-quality Alzheimer's care facilities tend to offer music therapy as a way to diminish patient anxiety, but that less-well-funded ones do not.
My goal this week is to locate some patients and patient advocates (i.e. sympathetic family members) in the Bay Area who are unable to get needed music therapy for autism, Alzheimer's, or depression. Please send any tips my way! My email is andrewrosenblum (at) gmail (dot) com
Posted by Andrew Rosenblum on 05/24/09 From Today's Contra Costa Times: California saw a twelvefold increase during the past two decades in the number of autistic people who are receiving services through regional centers, a new state study reveals. The dramatic rise in autism has broad implications for California families, taxpayers and social service agencies. "This is a shocking recognition of the challenges we face, today and into the future," said Rick Rollens, the father of an autistic child and a co-founder of the Medical Investigation of Neurological Disorders Institute at UC Davis.
Music therapy may be well-established in psychiatric hospitals,and as a way to communicate with advanced Alzheimer's patients -- but what about at the frontiers of scientific research?
Wanting to get an overview of cutting-edge research in the field, I was in touch with Harvard neurologist Gottfried Schlaug. Schlaug made headlines for a 2006 study that used brain imaging to prove that a singing technique called "melodic intonation therapy" helps "aphasic," or non-verbal, stroke victims recover the ability to speak. Right now he's working on a way to use singing techniques to improve speaking ability in autistic children. Like aphasic stroke victims, many autistic children can sing, even though their speaking ability is limited or even non-existent. Schlaug's hypothesis is that a combination of singing and motor therapies might serve as a "way in" to the minds of autistic children, helping them learn to speak.
But what about in the Bay Area, particularly in light of the Packard Foundation's report of an 183% increase in autism cases among local children between 2001-2007? It turns out there are people using cutting-edge music therapy techniques to treat autism here too. One of them invited me to observe a session with a 4-year-old boy with autism (We'll call him "Sam," although at the request of his mother, this is a pseudonym). Apart from the fact that the combination of singing and imaginative play in the therapist's playroom looked like a lot of fun, the improvement that Sam has shown was impressive.
Four months earlier, when he first began weekly sessions, Sam had a tiny vocabulary, in part because he didn't know how to say "what's that?" He tended to echo questions rather than answer them, and showed little penchant for imaginative play – classic symptoms of autism. But after regular sessions of a new form of music therapy specially developed for autistic children, Sam is now able to answer questions and ask them. As for play, he barely stopped singing, dancing, and moving toys around during the entire 50-minute session.
The therapist, a young veteran of the Peace Corps who just submitted his master's thesis on music and autism in April, says that the research for music therapy's effectiveness on autism is suggestive more than definitive. For example, in brain imaging of autistic children, their brains will not respond to spoken language -- but the same region will light up with activity in response to a piano chord. But he's confident that the research will eventually catch up to what he sees each day: the power of music to help autistic children learn to communicate
Posted by Andrew Rosenblum on 05/06/09I had a very informative interview last week with the director of music therapy at a local psychiatric hospital. He points out that music therapy has a long history, dating back to the 1950s, in treating severe depression, sucidality, psychosis, and what we know call PTSD. Since a PTSD sufferer continues to suffer from heightened levels of anxiety and intrusive memories of a traumatic event like a car accident or physical violence, music becomes a way for the therapist to draw the sufferer back into the present.
He might play a soothing piece of music as a way to help the patients "wash away" the distressing memories -- or patients might improvise on xylophones or sing together-- and then discuss how the music made each person feel. If a patient is isolated or paranoid, a drum circle is a non- verbal way to ease back into human interaction.
The therapeutic goal is to give the patient the tools to battle the distressing moods and find ways to live in the 'here and now." Music therapy in this psychiatric hospital is an adjunct of "cognitive behavioral therapy," -- a form of psychology that holds that through practice, thoughts can control moods. The music becomes a way to practice enjoying the present, and realizing that traumatic or unhappy memories of the past don't have to consume the rest of a person's life.
Since these techniques are well-established tools in the psychiatric hospital, he also gave me some very good ideas about were I should go next for more "cutting-edge" uses of music therapy.
You'll notice that I'm being a bit coy about who my source is, where he works, and his suggestions, because I don't want to give away the whole article before it's published. But I'm seeing that this is a burgeoning field, with a range of new science to support its anecdotal examples of efficacy. The U.S. News and World Report ran an excellent "round-up" of research last fall: http://health.usnews.com/articles/health/brain-and-behavior/2008/07/17/music-as-medicine-for-the-brain.html
Posted by Andrew Rosenblum on 04/06/09First of all, I want to thank my generous donors for their support. I think this story will end showing people that technology is not the only fix for serious neurological conditions.
As for the reporting, things are starting to happen. Last week, I spoke to Victoria Hughes, a classically-trained harpist who plays 4 hours every weekday morning at Alta-Bates Hospital in Berkeley, as does a colleague at Alta-Bates Summit Hospital in Oakland. Both Stanford Hospital and the UCSF Medical Center also pay professional musicians to perform in the hospital setting. Why would this seemingly aesthetic gesture get a funding increase in the age of the H.M.O.? Hospital administrators are responding to a series of studies showing a reduction in both anxiety and heart rate in response to soothing music. Hughes plays both popular music by the likes of Enya and recognizable classical "hits" like Puccini arias as a way to give people from a variety of backgrounds something with which to identify.
I've also been in touch with a couple of PTSD experts, although a music therapy program based in the V.A. Center in Waco, TX is the only confirmed music-based PTSD treatment program we've been able to locate so far. Dr. Joseph Bobrow of the Coming Home Project in San Francisco has offered to inquire at the S.F. and Palo Alto VAs on my behalf.
My goal this week is delve further into Alzheimer's treatments that use music therapy. The current theory is that music stimulates areas within the brain where emotion and long-term memory are processed. So even if other parts of the brain are damaged by Alzheimer's, a song with particular associations in a person's past can bring the once-confused Alzheimer's sufferer radiantly into the present. I'm scheduled to speak with a music therapist from a local psychiatric hospital on Thursday, and look forward to telling you about that conversation and others I hope to have this week.
Posted by Andrew Rosenblum on 03/23/09
