Singing the Shopping List: How Music Can Rewire the Brain After Stroke

In 2023, a stroke transformed Naresh Shanbhag, a 53-year-old smooth-talking sales professional in Bengaluru, into someone who was unable to speak words, let alone sentences. “I began physical therapy to regain strength in my paralyzed right side, but forming sentences or remembering the right words was hard for me,” he says. Initially, when a doctor friend suggested music therapy, Shanbhag thought it would be interesting, but was skeptical that listening to songs would help him recover.

That skepticism disappeared right away. “From the very first session, I was hooked,” he says.

Naresh Shanbhag with his beloved pooch, Cookie. Courtesy of Naresh Shanbhag

In a soundproof room in India’s first music cognition lab at Bengaluru’s National Institute of Mental Health and Neurosciences (NIMHANS), Shanbhag was given simple rhythms and beats to emulate. “I started with single beats, and as I got better, was able to tap out more complex beats on a smartphone app,” he recalls. “For the first time since my stroke, I felt a sense of achievement at every new task I mastered.”

When his therapist noted that he could sing more fluently than he could talk, he asked Shanbhag to sing sentences. “One year later, I still do this,” he laughs. “Every morning when I go to fetch milk and groceries, my shopping list is a song that I belt out!” Though Shanbhag’s speech is still halting, he and his wife believe that these sessions accelerated his progress.

The lab is run by Shantala Hegde, a professor of neuropsychology as well as a trained classical vocalist. She and her team of researcher-collaborators and PhD scholars provide rehabilitation services to dozens of patients per month who have brain injuries like Shanbhag, at a little over $42 U.S. for 20 sessions. “I’m in a government hospital, so our charges are very, very minimal,” she laughs. “In private settings, of course, this would cost 10 times or more.” They have been successful in helping patients regain functional speech, coordination and independence in daily tasks. Some, like Shanbhag, who had lost the ability to communicate, have recovered enough to manage everyday life.

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“Music is a powerful tool for neuropsychological rehabilitation because you engage the entire brain to engage with it,” Hegde says. The improvements do not come from simply listening to music, though that has its own well-documented therapeutic effects. “We give them specific musical exercises that engage the entire brain, activate different brain areas and strengthen the connections between them,” Hegde clarifies. “The type of music is immaterial, although in Bengaluru, we often use Indian music to make it more engaging for our patients.”

Rewiring the brain

At the crux of music therapy lies the fact that the human brain is plastic. Stimulated the right way, undamaged parts of the brain can actually rewire to compensate for the tissue affected by brain trauma. In 1890, the man often called the father of American psychology, William James, first described this as “plasticity,” or the brain’s ability to adapt through habit and experience. Around the same time, the Spanish neuroscientist Santiago Ramón y Cajal developed the neuron doctrine (the concept that discrete and independent cells make up the nervous system) and proposed that brain connections could be reorganized by mental exercises he called “cerebral gymnastics.”

Shantala Hegde runs the music cognition lab at Bengaluru’s National Institute of Mental Health and Neurosciences. Courtesy of Shantala Hedge

But it was not until 1973 that the first formal, research-based music therapy for stroke patients, Melodic Intonation Therapy, was developed. The technique uses the melody and rhythm of singing to help patients recover their ability to speak full sentences, exactly how Shanbhag learned to sing his grocery list out aloud.

Today, neuropsychological rehabilitation that uses music and rhythm has emerged as an evidence-based, non-invasive and non-pharmacological method to recover brain function after stroke and other brain injuries. Modern neuroscience, psychology and rehabilitation medicine converge into a series of tuneful techniques which Hegde and other rehab practitioners tailor to the individual needs of every patient. Rhythmic auditory stimulation is possibly one of the most frequently implemented. In this framework, musical rhythm serves as an external cue to help patients to modulate their movement. This has been found to be effective in helping patients with stroke and Parkinson’s disease to walk better, faster and with better balance.

Here is how music-based neuropsychological rehabilitation helps. First, rhythm helps the brain organize actions in time, like coordinating steps while walking, or structuring the flow of speech (this is why Shanbhag struggled to speak after his stroke, but found it easier to sing or speak in rhythm). Second, the patterns, repetition and melody of songs make information easier to store and recall. These patterns provide support to the brain as it relearns lost skills.

Using melody and rhythm

At NIMHANS, which is a government referral hospital, Shanbhag signed up for 40 one-hour music-based neuropsychological rehab sessions in addition to his ongoing physiotherapy. He enjoyed music therapy so much that he found himself looking forward to it. “Over time, I began to use beats and tunes to speak sentences,” he says. During the sessions, he practiced replicating rhythms, notes and pitches.

Hegde uses a mix of music-based neural rehabilitation techniques to treat patients like Shanbhag. First, she assesses the overall condition of every new patient. The potential for success depends on “the severity of [brain] damage, the amount of time the patient has had the condition and their cognitive reserves,” she says. Cognitive reserve indicates how actively the patient was using different parts of their brain before the stroke or injury. Social connections, emotional relationships, educational level, activity levels and other factors add to a person’s cognitive reserve and help Hegde assess if they will benefit from this form of therapy.

Naresh Shanbhag with his wife, Vidya. Courtesy of Naresh Shanbhag

In some cases, the benefits come almost right away. “If the patient has a mild brain injury, within a couple of weeks [of music therapy], you’ll start seeing changes,” Hegde says. Shanbhag, who completed his 40 sessions over the course of a year, is now able to speak coherent sentences, has begun to walk better and has even started an Instagram page to post music videos, a far cry from his condition after the stroke that weakened the right side of his body, made it hard for him to recall words and impaired his speech.

In spite of success stories like Shanbhag’s, more widespread use of music therapy has been hampered by two factors: Some randomized control trials have shown only moderate impact, and training, at least in India, has been slow. Hegde says that for this therapy to come of age, key protocols and conditions must be standardized. “As a clinician, if I have 100 cases, I can see what has improved, what’s working,” she says. “But from a research point of view, each of these cases may have different clinical background, different inclusion, exclusion criteria, etc.”

Hegde says that there are about 70 music therapy practitioners in India. “We need more trained people in the field,” she says. “That’s for sure.”

Some skeptics say that perhaps the neurological improvements after music-based neuropsychological rehabilitation could partly be because it is enjoyable, and patients are likely to follow it for longer. In comparison, physiotherapy can be exhausting and discouraging, and patients tend to drop out before it has had time to be effective.

While the scientific evidence for what Hegde and other practitioners are observing is still evolving, pop science is also having an impact on music therapy’s credibility. “So many musicians armed with some online certification programs are calling themselves music therapists today,” Hegde says. “But music therapy requires proper training and standardized, evidence-backed protocols.”

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Toward that end, teams of interdisciplinary researchers are now working to develop rigorous reporting guidelines for music-based interventions that could enable more widespread and mainstream use. This in turn could help experts develop a broader understanding of brain recovery, in which rhythm and music are recognized for the key role they can play in how the brain heals itself.

Meanwhile, happy that he has found his voice, Shanbhag serenades his wife with one of his favorite Bollywood songs: “I have a little, and need only a little more…”

The post Singing the Shopping List: How Music Can Rewire the Brain After Stroke appeared first on Reasons to be Cheerful.