ACADEMIC INNOVATIONS

ACADEMIC INNOVATIONS Institute Probes Music's Therapeutic Potential M.J. Friedrich T HE HEALING QUALITIES OF MUSIC have been appreciated since an- cient times. Today, music con- tinues to occupy a therapeutic niche in a range of settings and is gaining rec- ognition as a valuable complement to conventional medical treatment in a number of areas, such as relieving pain during childbirth (Pain Manag Nun. 2003;4:54-61). Rigorous evaluation of such effects is needed to ensure that music is used most effectively in patient care. Such an ef- fort is one of the aims of neurologist Mark Jude Tramo, MD, PhD, founder and director of the Institute for Music and Brain Science at Harvard Medical School, in Boston. Throughout his ca- reer, Tramo has used music as a lens to examine brain function. He envisions the nascent institute as an entity that will bring a multidisciplinary perspective to research on how the auditory cortex functions—not only to gain insight into fundamental auditory processes, but also to apply that insight to such problems as hearing loss and brain damage. LAYING GROUNDWORK Tramo has spent the last 2 years lay- ing the groundwork for the institute's activities. The group currently in- cludes a number of investigators affili- ated with Harvard Medical School. But a host of researchers with different areas of expertise will be required to fulfill the institute's goal of finding out "how music is understood by the brain, from the single cell on up to global process- ing" and applying that knowledge clinically, said Nicholas Zervas, MD, professor of neurosurgery at Harvard Medical School and an executive board member of the institute. Accordingly, the institute is ex- pected to draw from the large commu- nity of research scientists, clinicians, and other experts in the Boston area who are involved in auditory-related studies, from the very technical to more cognitive and therapeutic areas. A center such as this, said Zervas, a former president of the Boston Symphony Or- chestra, can encourage collaboration among these experts. ROCK 'W ROLL HEART A musician and composer as well as a physician-scientist, Tramo, a neurolo- gist at Massachusetts General Hospi- tal and an assistant professor of neu- rology at Harvard Medical School, represents the convergence of music and science. Growing up in the 1960s in an area of the Bronx that was home 7559 1AM.A, Apnl 7, 2004—Vol 291. No 13 (Reprinted) to Dion and the Belmonts and the Young Rascals, he played guitar in a rock band while in grade school, per- forming at the New York World's Fair in 1965. In high school he began com- posing songs, including a rock musi- cal, "Apotheosis of the King Who Lost His Kingdom," which he recorded for Columbia Records. Tramo's musical pursuits eventu- ally took a back seat to his research in neuroscience, but not without strongly influencing his research path. He now studies how the auditory cortex pro- cesses pitch, harmony, melody, and other aspects of music, and works with patients with epilepsy, stroke, and other conditions to understand how brain damage affects music perception. In- tuition from his musical background "helps me be creative with experi- ments, thinking about how the brain functions," he said. The institute's mission is ambi- tiously broad, ranging from advancing knowledge of the neurobiological foun- dations of music, to rigorously evaluat- ing and quantifying the healing effects of music on various disease states. In ad- dition, Tramo foresees that insights from the work could lead to new technolo- gies to promote health and treat dis- ease, or improve established technolo- gies, such as cochlear implants. NAME THAT TUNE Christine Koh, PhD, a postdoctoral fel- low at Harvard Medical School, is col- laborating with Tramo to study music perception in patients with brain le- sions caused by stroke or epilepsy. like Tramo and many others who study the neurobiology of music, Koh (who stud- ied violin for 12 years) is a musician as 02004 American Medical Association. All rights reserved. EFTA00304437 well as a scientist. She is combing a large database of stroke patients at Massa- chusetts General Hospital, looking for individuals with specific types of le- sions in the auditory cortices. These pa- tients are undergoing a variety of tests designed to provide a broad picture of the nature of their deficits in music perception. Koh and Tramo are also studying pa- tients with epilepsy who plan to un- dergo a therapeutic temporal lobec- tomy or excision of a piece of their auditory cortex—dramatic procedures used to alleviate seizures that severely compromise quality of life. Unlike in- dividuals who have experienced a stroke, this group of patients will allow the re- searchers to compare musical capabili- ties before and after the procedure. Simple tests—such as asking pa- tients to decide if one tone is higher or lower, longer or shorter, or louder or softer, than a second tone—accecc pitch discrimination. Other tests probe such abilities as being able to determine whether two melodies are the same or different. "The remarkable thing—and one of the reasons that music research is so fas- cinating—is that you can do a lot of this testing with people who don't have any musical training," noted Koh. Due to early exposure or intuitive sense, hu- man beings seem to have an inherent musical sense, she said. One of the goals of Koh's research is to determine whether low-level func- tions such as pitch discrimination are related to higher-level cognitive func- tions such as melody processing. "While some of this work is very ba- sic, it will provide us with the founda- tion to get a better understanding of how the auditory system is laid out," she said. "That will help direct us to practical therapeutic applications." BREAKING THE CODE Another member of the institute, Pe- ter Cariani, PhD, assistant professor of neurocomputation and neurophysiol- ogy at Harvard Medical School, wrestles with the issue of how the brain repre- sents sounds, from music to speech. A key problem concerns understanding how information is encoded by neuro- nal spike patterns. Cariani likens this problem to the co- nundrum biologists faced before the dis- covery of DNA. "Classical geneticists knew that information was encoded somehow, they knew there was a mecha- nism of inheritance, that it was precise and reliable," he said. But they did not know whether the information was en- coded by proteins or DNA, or how the code worked. Neuroscientists face an analogous dilemma in trying to understand the nervous system without knowing the "neural code," he said. "We don't un- derstand the neural codes, we don't un- derstand the nature of the coding of the information in the central nervous sys- tem," Cariani explained. "It's hard to understand informational processes if you don't understand this." A better understanding of neural cod- ing has practical applications, said Cari- ani. For example, cochlear implants have been developed by trial and er- ror, to a large extent, without a very ex- plicit notion of neural coding in the au- ditory nerve. But if scientists succeed in cracking the neural code, the ad- vance could lead to improvements in the devices. SOUNDSCAPING While basic neuroscience research is an integral aim of the institute, it is im- portant not to lose sight of the fact that music and other components of the acoustic environment can help pa- tients feel better, said Tramo. With that in mind, part of the insti- tute's mission is to raise awareness about the importance of improving the "acoustic ecology," or soundscaping, of hospitals and clinics. Tramo believes that just as attention is paid to the art that adorns the walls of hospital cor- ridors and patient rooms, the sound- scaping of these areas should also be addressed. A pleasing acoustic environment with music and natural sounds can help to ACADEMIC INNOVATIONS mask background noise—and per- haps even speed the healing process, said Tramo. Some studies have shown that enriching the acoustic environ- ment of neonatal units with music can increase the speed at which preterm in- fants gain weight and reduce their length of stay in the unit, he noted (bit J Arts Med. 1997;5:4). Future research plans include iden- tifying the types of music and envi- ronmental sounds that have positive health effects on mood, blood pres- sure, or immunologic measures, for example. Bernie Krause, PhD, a bio- acoustic researcher and member of the institute's advisory board, noted that although he and others have gathered anecdotal information on the beneficial effects of natural sounds— such as reducing the amount of pain medication patients require in some situations—more objective data are needed. To this end, Tramo and Krause (presi- dent of Wild Sanctuary Inc, a California- based company that produces natural sound recordings for soundscape de- sign, and a former member of the folk group, The Weavers) hope to evaluate the effects of such sounds on individu- als with such conditions as anxiety, depression, and pain. As the research proceeds, efforts are also under way to secure a funding base from public and private sources to take the institute to the next phase, from a loose collection of like-minded collabo- rators to an entity with a full-time complement of researchers and oth- ers, said Douglas Brightbart, JD, the in- stitute's chief operating officer. Tramo predicts that exploring the neurobiological foundations of music is likely to provide insights into the neurobiology of perception, perfor- mance, development, plasticity, emo- tion, and learning. But it's important to keep the focus on trying to help people, he said. "That's a major goal of the institute, to carry out studies well, and if they really do show positive effects [on health), to deliver these benefits to patients." O2004 American Medical Association. All rights reserved. (Reprinted) JAMA, April 7, 2004—Vol 291, No 13 1555 EFTA00304438