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Published: Thursday, 05 December 2024 at 09:30 AM
Music can help tackle multiple sclerosis – here are the scientific benefits
Read on to discover the scientific benefits of music for multiple sclerosis….
Jeff Beal… a composer living with multiple sclerosis
Jeff Beal is perhaps best known for his brilliant score for the US version of House of Cards, the dark political TV thriller. His opening theme is ominous, intriguing and intoxicating – and the score has won him two Emmy awards. Yet the album that’s gained the American composer, now 61, over three million streams online in the first four months of its release in 2024 is a much more intimate affair. The New York Études (released on Platoon) are for solo piano, played by Beal himself – and they have a powerful personal story behind them. Beal wrote these etudes not with public performance in mind, but as personal pieces to play each day, as part of how he manages living with multiple sclerosis (MS).
When Beal was diagnosed with MS in 2007, it was ‘terrifying’. His reality shifted. Not only did he have to come to terms with having a chronic illness, he had to manage it in the cut-throat world of film and TV, not known at the time for its progressive attitudes to disability. ‘People told me, “You can’t be sick in Hollywood”,’ he recalls. Beal felt he had to downplay his condition for years, but he talks about the reality of his MS now – in part because he wants to give hope that a diagnosis doesn’t mean giving up on life. While he was successfully composing for the biggest names on screen, Beal also got to grips with understanding his MS – and the important role music could have in the long term.
What is multiple sclerosis?
MS is a neurological condition that damages the nervous system. The nerves are mistakenly attacked by the immune system, causing a wide range of symptoms and making it complex to diagnose. The Multiple Sclerosis Society in the UK lists fatigue, tremor, pain, vision problems, numbness, tingling and problems with memory and thinking, among others. In the UK, more than 150,000 people have MS, with over 7,000 newly diagnosed cases each year.
Currently, there’s no cure. How MS affects an individual also depends on the type: the rarest, ‘primary progressive’, sees symptoms consistently increasing; 85 per cent, meanwhile, will have ‘relapsing remitting’ MS, which sees symptoms come and go; ‘secondary progressive’ MS can follow, which again sees symptoms remain constant and get slowly worse, writes the NHS.
Jacqueline du Pré, Alice Sara Ott and multiple sclerosis
For years, the plight of cellist of Jacqueline du Pré has been the first story many music lovers think of in relation to MS. The remarkable cellist, whose impassioned recording of Elgar’s Cello Concerto gained legendary status, began to experience numbness in her fingers in 1971. She was diagnosed with MS two years later. ‘I remember arriving at Philharmonic Hall and suddenly not being able to open the cello case and thinking what is wrong?’ she told one interviewer. At the age of 42, in 1987, she died.
More recently, in 2019, the renowned pianist Alice Sara Ott was in the headlines when she spoke publicly about her MS diagnosis. She spoke on her Instagram account about the ‘rollercoaster of feelings of panic, fear and devastation’ she went through. Happily, several years on, Ott’s treatment with medications means she is symptom-free and able to continue her international career. ‘I’m not living my life despite having MS; I live my life with MS,’ she told The Sunday Times. There’s a whole spectrum of experiences between those of Du Pré and Ott, in which medication, physiotherapy and a range of therapies can help to manage MS.
Music helps to reduce stress and improve wellbeing
Music, in general, is known to be good for well-being and reducing stress, and in Beal’s experience that’s even more important with MS. ‘Stress is an invitation for the symptoms to exacerbate themselves and so anything you do as a daily practice that not just quiets but focuses the mind really does wonders,’ says Beal, who sees his daily piano practice as a ‘meditative ritual’.
His anecdotal observation is backed up by data – to give one example, a review of 26 studies across the UK, Australia and US, published in the Journal of the American Medical Association Network Open in 2022, found that ‘music interventions are linked to meaningful improvements in wellbeing’. And Nordoff and Robbins, which is the UK’s largest music therapy charity, writes that in general ‘music has been shown to lower levels of the stress hormone cortisol, as well as decreasing your heart rate and blood pressure’.
Those wellbeing benefits apply to anyone – whether living with a chronic illness or not – as do other positives that often come with music-making, such as being part of a like-minded community and having an outlet for personal expression.
Music can improve brain neuroplasticity… and manage the symptoms of multiple sclerosis
One of the most interesting growing areas of scientific research into music, which has a particular relevance to MS, is neuroplasticity – that is, the capacity of the neurons and neural networks in the brain to strengthen, reorganise and restructure or, in other words, to rewire themselves.
Beal began reading books about brain plasticity after his diagnosis, and he also began to play the piano every day. ‘I was really going into the Schmitt book [Preparatory Exercises for the Piano], which features these tongue-twisters for your digits. I could barely do some of them,’ he says. ‘I’d just do them the next day slowly. And then magically, after a few days, it started to happen. You are building a neural pathway in your brain to train your fingers. The coordination is a neural pathway.’
Developing new neural pathways, getting round the nerve damage caused by MS, can improve symptoms. Of course, Beal has been a musician his whole life, and in many ways he is primed for music to be beneficial to his brain. ‘Most of my brain lesions [areas of damage caused by MS] were in the corpus callosum, when I was first diagnosed, which is the area that connects the left and right hemispheres of the brain,’ he explains. ‘The fascinating thing is that this area of the brain is usually hyper-developed in musicians of all types.’ Playing music requires both hemispheres for fine motor skills, as well as needing both the creative right and linguistic, logical left sides of the brain, so playing the piano is essentially a workout for the entire brain.
Multiple sclerosis and music therapy
There is growing evidence that music also has huge potential for improving the quality of life and managing the symptoms of people with MS who don’t have significant prior musical training. In Germany, Barbara Weinzierl is the music therapist at the leading clinic for MS treatment and rehabilitation in the country, the Neurological Rehabilitation Centre Quellenhof. Music therapy is one of the options available to their patients, who generally come to the centre for three to five weeks, and number around 160 at any time.
Weinzierl leads small group sessions, which follow a set structure and routine. Over the course of an hour, they improvise music three times (with Weinzierl weaving it all together), as well as doing a breathing exercise and talking about their experience. The sessions aim to help the participants relax, explore their creativity, train mindfulness, do muscle exercises (such as movement of the arms and hands) and improve core stability and patients’ ability to stand up.
The best instruments for multiple sclerosis therapy
Some of the instruments used in the sessions are familiar from mainstream musical settings: the bongo drums, for instance, and the conga. Others are specially designed. One is the HAPI – or hand activated percussion instrument. ‘It’s a drum that offers music therapy for the hands. You put your hand on top of the instrument, and you have a stick in the other to play the drum. It makes beautiful sounds, and the vibration goes directly inside your hand,’ says Weinzierl. ‘Often people experience this gentle vibration and after playing it they can move their fingers in a better way, because the nerves are working better.
Using musical vibrations to stimulate nerves
‘Instruments make vibrations when they are played, and because you’re in touch with instruments, the vibrations stimulate the nerves,’ continues Weinzierl. ‘If the nerves are working better, that’s good for MS. Many of our patients are paralysed or have funny feelings in their hands or feet. Sometimes they haven’t felt anything for, say, two years. They come to us and experiment with vibration and suddenly they feel something. Vibration is a big part of music therapy, and it’s the only therapy in our centre where we use vibration in a focused way for our patients.’
The Big Bom… a breakthrough instrument for the treatment of multiple sclerosis
The potential power of musical vibrations to improve MS symptoms is one of the most exciting areas of Weinzierl’s practice and research. At the start of her career in music therapy, around 15 years ago, she came across an instrument called Big Bom, which is a large log drum, over a metre long and half a metre wide. Immediately, she had an instinct it might be beneficial. ‘It’s a sort of bench you can sit on upright, like a horse, and you have two big sticks [to play it]. It’s a bass drum so it makes a huge vibration,’ she says. ‘You’re training core stability and right-left coordination, but because you’re sitting on it, you can feel the vibration through the pelvic floor and in the back.’ Big Bom has become their ‘miracle instrument’, says Weinzierl.
‘From the beginning, the feedback was spectacular,’ she says. ‘Patients said they played on it for ten minutes and could walk better.’ That feeling lasted for some three or four hours, and patients felt something was different afterwards. Weinzierl observed this in her patients for around five or six years but couldn’t find anything in the scholarly literature about the phenomenon. However, the Quellenhof clinic’s chief doctor agreed something interesting was happening, and the pair wondered if the vibrations were stimulating the vagus nerve. This long cranial nerve – in fact, two bundles of nerve fibres – runs from the brain down through the body and is a key part of the parasympathetic nervous system, which helps rest, digestion and relaxation.
Music and multiple sclerosis… a promising future
A pilot study of six people gave Weinzierl the results she’d hoped for, showing that using Big Bom improved gait and stability in the legs. She’s now about to launch a much larger clinical trial designed to evaluate the effectiveness of music therapy on gait function among patients with MS. The condition is still under-researched compared to other neurological conditions – ‘I think the name of the disease explains it. It’s multiple. Every part of the brain can be influenced, so you can have five different patients with five totally different outcomes of the disease.’ But the research into music’s potential to improve not only our emotional and mental health but our physical health too is growing, and while much is still unknown, what is clear is that music does have the power to improve the lives of people with MS.