Choir Helps Stroke Survivors Regain Their Voice
Randy Kernus was not expected to live. Nine years ago the then 51-year-old was headed to work near his home in Northern Virginia when a tangle of abnormal blood vessels on his brain started to bleed.
He doesn’t remember anything from that day — neither the rush from one hospital to the next nor the diagnosis that followed: a massive hemorrhagic stroke that required a major operation to remove the cluster of vessels that caused the bleeding.
Kernus survived the trauma, beating the experts’ initial predictions. But the stroke left him partially paralyzed and nearly speechless from Broca’s aphasia, a common stroke-associated injury that affects one’s ability to produce words, even though language comprehension typically remains intact.
After several weeks of routine rehabilitation therapies, the paralysis went away. Kernus’ speech, however, was slow to return. More than a year after the stroke, he still wasn’t speaking in complete sentences, and that terrified his wife, Laura Obradovic.
“His neurologist had told us, ‘Wherever he’s at 18 to 24 months after the stroke, that’s probably the best he’s going to be,’ ” Obradovic recalls.
Refusing to accept her husband’s stalled progress and stunted sentences as their new normal, Obradovic enrolled in a nearby support group for stroke survivors and their caregivers, hoping to learn about other interventions from those who were going through the same thing.
That’s where they met Tom Sweitzer.
Survivors who sing
Standing over a keyboard at the front of a beige conference room on a satellite college campus in Loudon, Virginia, Sweitzer, a music therapist, addressed the dozen or so adults seated in front of him. Some were joined by caregivers; others came solo. Everyone held sheet music.
“Let’s start by telling us one of your favorite Thanksgiving traditions,” Sweitzer said.
The group, a choir of stroke survivors that goes by the name Different Strokes for Different Folks, had just finished a more traditional vocal warm-up. But this next exercise wasn’t for the voice; it was for the brain.
The singers went around the room and traded stories of food and family. When it was Kernus’ turn, he told the group, “Pumpkin pie is one of my favorites. But on top of that, obviously, it’s football for me.”
Nothing about his sentence was incomplete.
“It’s just really, really impressive,” Obradovic says about her husband’s progress since joining the stroke choir five years ago, despite having no previous experience or even an interest in singing. “Randy has come leaps and bounds from where he was” when doctors predicted he would likely not see further improvements in his speech.
The breakthroughs Kernus has experienced since joining the stroke choir are not unique. Music therapist Skylar Freeman, who works with Sweitzer and the stroke choir, sees progress like his all the time. When she joined the group, three years ago, Freeman says, it was “really difficult” to understand what many of the members were trying to communicate. Sentences were short and often incomplete, and pauses between words stretched several seconds.
“And now it’s like full sentences — very quick, super responsive,” she says. “Some people say that it’s like magic. I don’t think it’s like magic; it’s like music. That’s just really what it is.”
Drop the melody, but keep the words
Researchers and therapists have long known that people who can’t speak after a brain injury, including stroke, usually can sing. For the majority of the population, words and music are produced in similar ways but on opposite sides of the brain — speech on the left and song on the right — explains Kathleen Howland, a music therapist, speech therapist and professor of music therapy at Berklee College of Music in Boston.
“And what is so fascinating about music and the brain is when speech goes down, music typically does not,” Howland says.
But speech and music also share a network. And studies have found that singing can help rebuild speech pathways. This is one reason why Sweitzer and a team of therapists from his Middleburg, Virginia, nonprofit, A Place to Be, work with stroke survivors on singing everyday phrases, including what they want to eat and how they feel in a particular moment. The goal: One day they’ll drop the melody but keep the words.
Brandon Hassan, a music therapist who works with the choir, demonstrates this by tapping his leg and slowly singing, “I’m feeling sad.” All too often, he says, people with aphasia resort to words or phrases that come easily, and “I’m good” is one of the phrases he hears regularly.
“Someone could be very upset in a moment, but that’s the phrase that’s easy to put out there into the world,” he explains. “So we can work on that emotional vocabulary and help provide those phrases that are functional so that we don’t always just have to say ‘I’m good’ because it’s the easiest thing to say.”
At their weekly rehearsals, the singers are challenged to fill in missing lyrics to familiar songs, which may be top of mind but not tip of tongue. For example, the therapists will sing “All you need is …” and wait, no matter how long it takes, for someone to say “love.” The group also writes original songs, which requires members to come up with, and remember, words to an unfamiliar melody.
“People who stutter after their stroke, they don’t stutter when they sing,” Sweitzer notes. “When something inside of your brain dies, the simplest beat … and a simple sound can open up your brain to want to grow again.”
And figuring out how those “simple sounds” trigger healing pathways in the brain is exactly what one of the world’s leading biomedical research institutes has set out to do.
Synching science with song
In June 2015, National Institutes of Health Director Francis Collins found himself at a dinner party with “a rather distinguished group of people,” just outside the nation’s capital.
Supreme Court justices Anthony Kennedy, Antonin Scalia and Ruth Bader Ginsburg were in attendance, and the mood was “tense,” to say the least. The dinner took place the same week the court had issued its ruling on gay marriage, “and there was not full agreement amongst those three Supreme Court justices about whether they got it right,” recalls Collins, a physician who is known for his work on the Human Genome Project.
In an effort to lighten the mood, the geneticist and amateur musician grabbed his guitar — Collins admits he “sometimes” brings it to social events — and jumped onstage with the bluegrass band that was there entertaining the guests. World-renowned soprano Renée Fleming, who was also at the dinner, joined him.
“The whole evening changed. People began to sort of relax out of their tension zones,” Collins says. “Antonin Scalia — smoking a cigar, raising his glass of brandy — lustily sang along as we joined together for a rendition of the Bob Dylan anthem ‘The Times They Are A-Changin,’ which seemed particularly appropriate. And, I confess, I chose it for that reason.”
The impromptu performance by the scientist and the soprano not only saved the fate of the fete but also prompted the duo to launch a joint research endeavor between the NIH and the John F. Kennedy Center for the Performing Arts to explore the link between music and health, called the Soung Health Initiative, in partnership with the National Endowment for the Arts. In September the NIH announced a $20 million investment to fund the initiative’s first round of studies.
“You wouldn’t, at this point, say music therapy is a well-worked-out science,” despite a small body of research showing its effectiveness, Collins says. But newer technologies and a better understanding of how the brain works are making it easier for scientists to home in on how music affects the brain.
“And we know it affects you,” Collins adds. “When you hear a piece of music that’s particularly important to you, it makes you stop where you are. You might get a chill or some other experience. It’s really getting in there, in your brain circuits, and having a profound effect.”
“Some people say that it’s like magic. I don’t think it’s like magic; it’s like music.
- Music Therapist, Skylar Freeman
Some of the NIH-funded projects are looking at how music may be able to help improve walking ability in people with Parkinson’s disease. Another looks at the potential for music to reduce the likelihood that patients in intensive care will develop delirium — a common complication in hospital care, especially among older adults. There’s also a study underway examining music’s potential to improve physical and mental health in older adults with cardiovascular disease.
It will be a few years before the results from the Sound Health Initiative research come to light, but once they do, Collins expects that the field of music therapy will “really gather momentum.” And with more “solid evidence,” Collins is hopeful that music therapy will become a standard treatment for many common health conditions — one that physicians prescribe and third-party payers cover.
“Wouldn’t it be great if for pain, music was the first prescription before you get to any kind of pain relievers?” Fleming, the soprano, adds.
That might not be too far from reality.
Music taps into memory
Zoe Gleason Volz was packing up her collection of maracas, bells and tambourines after leading a music therapy session at an assisted living facility in Manassas, Virginia, when one of the adults leaving the room suddenly burst into song.
“We’re off to see the wizard,” the woman, in her 80s, sang.
Volz whipped around and joined in: “The wonderful wizard of Oz!” The two continued through the next several lines of the song. Just a few minutes earlier, the woman belting out the famous Judy Garland tune struggled to piece together details from everyday life. The words to the song from the 1939 film, however, flowed naturally.
“Sometimes you stumble into these really wonderful areas where you trigger a memory,” says Volz, a music therapist at Neurosound Music Therapy in Fairfax, Virginia, who often works with older adults who have memory issues. “After this session, a lot of the time, many individuals will continue to tell me stories. … So you’ve definitely hit something, and the brain is awake and active.”
Music’s effect on memory is another area of study being funded by the NIH. Specifically, scientists are looking at how memories are triggered by music and how music may help consolidate memories.
Research shows that music may provide relief from some symptoms associated with memory loss. Listening to music can reduce anxiety and agitation in people with Alzheimer’s disease, for example. It may also lessen their need for antipsychotic and antianxiety medications.
And similar to stroke recovery, music can be an effective way to communicate with people who have cognitive complications, explains Kelsi Yingling-Tafaro, a music therapist and executive director of Neurosound Music Therapy.
Some of the adults she works with don’t always process verbal instructions. “But if you sing the directives, they are very compliant. They understand what you are saying, and they are able to communicate with you through singing,” she says.
Other studies have found that music can help with memory recall and enhance people’s awareness of their current environment. This may be because musical memories are stored in a part of the brain that remains relatively undamaged by Alzheimer’s, researchers suggest.
“There’s something about music that taps into who you are,” the NIH’s Collins says. “It allows people who’ve kind of gotten lost back in the fog to come back out again with a familiar song and interact and experience enjoyment again.”
What’s more, music allows people to experience that sense of enjoyment with others.
More than medicine
It was the day of the annual holiday concert — a performance the Different Strokes for Different Folks choir had spent months working toward. The singers, dressed in festive holiday attire, sat onstage at a local school in a row of chairs arranged in an arch, waiting for the program to start.
Everyone was there — that is, everyone except Kernus.
Suddenly, his face appeared on a large screen, stage right. The show was ready to start. Kernus no longer lives in Northern Virginia, where the stroke choir is based. He and his wife moved to North Carolina in October of 2019, to be closer to the beach — a retirement dream they pushed up once Kernus showed significant progress in his stroke recovery.
But despite the distance, Kernus is very much still an active member of the choir. He can’t imagine leaving, so each Wednesday he dials into practice through videoconferencing and participates in performances the same way. And it doesn’t seem strange to anyone involved.
The sense of community among the choir members is unlike anything Sweitzer has seen. Along with singing together, the group watch movies, go horseback riding and schedule walks, he says. They’ve helped one another overcome seemingly impossible obstacles and have been a source of comfort during times of devastating loss.
“Many of these individuals, they don’t live like they used to live,” Sweitzer explains. “Many of them will never drive again; some of them have actually lost their spouse through their episode with their stroke. So feeling isolated in a world where maybe other people might not understand the challenges that you have every day, and then coming into a social situation where there are people just like you … they call each other a family.”
And experts say that might be yet another key to music therapy’s success.
“Wouldn’t it be great if for pain, music was the first prescription before you get to any kind of pain relievers?”
Social isolation and loneliness have been linked to several health problems, including high blood pressure, heart disease and Alzheimer’s disease, according to research from the National Institutes on Aging. And being cut off from communicating with others because of stroke-related aphasia can trigger feelings of isolation, music therapist Hassan says.
“The common theme that all of them said they experienced was the feeling of being alone in the world,” Hassan observes. “To have this group is huge for them, because they can come together and know that everyone is on the same page as them. … Everyone has context and knows what they’re going through.”
But music’s connective power may also be what keeps music therapy from being a routine part of medical care. “I think we wonder, How can something that is so emotional and so spiritually moving … how can that really attach itself to clinical and scientific outcomes?” Sweitzer says.
That’s where the Sound Health Initiative comes in. Collins says the goal of the project is to merge two fields that have been traveling in parallel, so that everyone involved can learn more about how music fits into medicine.
“The sparks that fly” when two seemingly opposite fields come together “is really the way new discoveries happen,” Collins says. “I’m counting on that happening here, and we’re already starting to see some evidence for that.”
“We are desperately looking for hope, desperately looking for healing,” Sweitzer adds, pointing to a lack of medical cures for Alzheimer’s and so many other diseases that haunt humanity. “And I think science is finally opening the door to the power of music.”