We have an exciting story to release today. Not only because our reporter, Andrew Rosenblum, put together a fantastic multimedia story that dives into how hospitals use music therapy but also the method of distributing this story.

The startup NewzPool (still in beta) refunded the original donors and we are using their technology to distribute the piece. Anyone can request to republish this story  just by going to NewzPool’s test site and submitting a request. It comes with their advertisements but you can customize the look and feel of the story. They’ve been great to work with and represent a different angle towards sustaining journalism. We wish them luck and hope to work with them again.

And now for your reading pleasure…

Music May Be the Best Medicine for Disabled Brains

BY Andrew Rosenblum, Spot.Us

SAN RAFAEL, CALIF –– ‘What do you see, oh, Aiden, oh Aiden?’ sings a 37-year-old music therapist named Pierre Brennan, strumming his guitar. He and 6–year–old Aiden Stewart peer into ‘Richard Scarry’s Best Word Book Ever’. ‘Where’s the pig?’

‘He’s right on the mud,’ Aiden says.

As part of an exercise program that she calls \”Movercise,\” music therapist Megan Edmontson sings with residents of the Memory Care Unit at the Veteran’s Home of California, in Yountville, Calif.

AUDIO FILES: Movercise | Where is the squirrel?

For Aiden, who has autism, this appropriate answer is the mark of real progress. When first diagnosed at 3, Aiden barely spoke at all and shunned interaction with his classmates, preferring to peer at the digital display of the classroom’s CD player. Since most autistic children have an affinity for music, Brennan teaches verbal skills through song, using the music as ‘training wheels’ that he slowly takes away over time, eventually leaving the pair conversing in ordinary speech.

For brains affected by autism, which occurs in 1 out of 150 children, or other serious neurological conditions like Alzheimer’s disease, severe depression, and stroke, music can be a powerful form of treatment. Rather than relying on high-tech tools or cutting-edge drugs, music therapists have devised sonic exercises that help the brain heal, soothe, or re-train itself.

Rather than relying on high-tech tools or cutting-edge drugs, music therapists have devised sonic exercises that help the brain heal, soothe, or re-train itself. Though well-established in the Veteran’s Affairs (V.A.) system and in some psychiatric hospitals, and supported by a growing body of research, music therapy is dogged by insurer skepticism that music is not medicine in the same way as surgery. Even when music therapy is an effective way to reduce the symptoms of hard-to-treat neurological conditions, it is often available only to relatively well-off patients. Brennan’s clients in affluent Marin County, just north of San Francisco, pay $100 per hour out-of-pocket for his services, although fees vary widely depending on specialty.

“Music is patterns and structure, and kids with autism are driven toward that and they attend to patterns and structure,” Brennan says, who calls his practice “Developmental Rhythms.” A former Peace Corps volunteer, Brennan just finished his master’s degree in music and is in the process of completing his various certifications as an autism specialist. “Joint attention is such a challenge for kids with autism. But once you have their attention, you can teach them a lot of different things.”

“His speech was really delayed, and still is,” says Aiden’s father Matthew Stewart, who works as an electrical contractor in nearby Fairfax, Calif. “But what’s really wonderful about music therapy is that it made him want to speak.”

Brennan is a pioneer in applying the codified set of techniques known as “neurologic music therapy” (NMT) to autism, an area where music therapy research is suggestive but not definitive. NMT was originally devised by Michael Thaut, a professor of neuroscience and music at Colorado State University, as a way to provide uniform, scientifically sound standards for music therapy applications. NMT has had success helping victims of neurological diseases like stroke, brain injury, and Parkinson’s disease improve their ability to walk steadily, and shows promise as a tool for speech rehabilitation.

“Traditional music therapy struggles with the science,” Thaut says, author of the 2005 book “Rhythm, Music, and the Brain.” “Neurologic music therapy has a very good research base that’s developed over the past 15 to 20 years. The latest area that’s been coming into play in the last few years is cognitive training, using music for attention training, memory training, and executive function.”

Cognitive training is particularly helpful for veterans who have suffered traumatic brain injuries, from causes like combat, toxic exposure, or stroke. The recovery process requires hours of painstaking memory, attention, and decision-making exercises, with the goal of aiding the injured brain in regenerating new cells.

James Gardiner, a neuropsychologist at the V.A. Black Hills Health Care System in South Dakota uses more than 80 NMT techniques to make the exercises more fun and engaging. Music stimulates the limbic system, the part of the brain involved with emotions.

“With music, you’re dealing with a more desirable and energetic way of approaching things,” Gardiner says. “I’ve found that when I had people around tables, at computers, the mood is one of work and drudgery. Whereas with music, the mood is very upbeat.”

The musical exercises are also a way to connect with recovering soldiers who are used to stoically enduring suffering – not actively working on it, or talking about it, with others. They are frequently battling depression because of diminished memory and decision-making skills.

“‘As veterans,-’ I tell them, ‘Your brain cells are like new recruits – or like a bunch of soldiers that have gone awry, and headed out all over the hills and, down by the valleys and streams,’ ” says Gardiner. “Music is what blows the bugle call of assembly – and gets everyone to march in order, so that everyone is together. And they like that metaphor.”

Music therapy has a long history in military hospitals, as the discipline began after World War II as a way to treat veterans struggling with the psychological fallout of combat – and the practice continues today in facilities like the Veterans Home of California in Yountville, CA. Through music, patients like Rick have gingerly re-entered relationships with other people (his therapist asked that his last name not be used). Held for two years as a prisoner of war in Vietnam, he was also a witness to the My Lai Massacre in 1968. His war memories continue to cause him the intense anxiety typical of Post-Traumatic Stress Disorder , and he is also afflicted with schizophrenia and incipient dementia. After his return to the United States he was placed in a locked facility as a threat to himself or others, and his levels of anxiety were so high that he refused roommates and had little human contact.

But he has made large strides in recent years, moving out of the locked facility and accepting a roommate. In addition to drawing, Rick sets his own poems to music, and also picks up his guitar and harmonica to play the songs of his youth, like “Travelin’ Man” and “Blowin’ in the Wind.”

The Home’s music therapy internship director, Megan Edmontson, who plays with Rick once a week, points out how singing has helped lessen his anxiety, such that he now will occasionally venture into the main ward and give brief concerts for the other residents. Singing also helps reduce his tendency toward “word salad,” in which a person with schizophrenia loses the ability to differentiate his own words, instead slamming them into a slurred jumble.

“The individuals here who have speech impairments, no matter what the condition may be, whether it’s a stroke or some kind of brain trauma, they can sing clearly. It’s audible, there’s no strain, there’s nothing blocking what they have to say,” Edmontson says. “But when you take the music away and are speaking with them in a normal conversation, it’s difficult for them just to put the words together.”

Multiple therapeutic techniques draw their power from that key insight, that a disabled brain can still use words that are embedded in music, even if normal language use is otherwise impaired. Pierre Brennan points to research suggesting that autistic children hear language “musically,” meaning that their brains sometimes process language with the right side of the brain, rather than with the left-side where language use is typically centered. For reasons that experts do not fully understand, Alzheimer’s disease ravages brain function, but leaves long-term musical memory relatively untouched. That means that even severely-impaired Alzheimer’s patients can still remember favorite songs of the past, and music therapists can use these song memories to get the attention of patients to do basic physical exercise, and also to improve mood.

Though both Gardiner and Edmontson work with Alzheimer’s patients in the V.A. system, skilled nursing homes that care for civilian Alzheimer’s patients typically view music therapy as a luxury that patients can forego.

“I think music therapy would be very helpful, but most nursing homes are for-profit,” says Jeanie Kayser-Jones, a UCSF professor of nursing who has studied nursing homes for 25 years. “And music therapy is not a requirement, so they don’t provide it.”

It is with conditions like Alzheimer’s and autism, where music therapy can reduce symptoms but not provide a definitive cure that funding tends to be most scarce. Quality of care becomes a question of ability to pay out-of-pocket – and whether the family is willing to battle insurers or state agencies for funding.

“Our system does not work for the meek, the timid, or the afraid,” says Judi Sheppard, the mother of a severely autistic 13-year-old boy in San Rafael, Calif. Sheppard was able to get her local California regional center, which allocates disability funding, to pay for music therapy for her son by twice appealing denials. “People that are afraid and don’t want to ‘go against the man,’ aren’t going to get anything.”

An update from reporter Andrew Rosenblum for his ongoing reporting: “How are Bay Area Hospitals Using music therapy for neurological diseases?” You can see all his updates in the middle column of the pitch. Please support Andrew’s work.

From Andrew

Music in the Yountville Veteran’s Home

I 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 one on one 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 seeing 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.

Treatment, But Not a Cure

I had an email message from music therapist Andrew Samson, 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 Samson 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.”

Our reporter Andrew Rosenblum continues to examine how Bay Area hospitals are using music therapy and other alternative treatments for neurological diseases. Today he provides us with two important updates. If you want to support his reporting, you can do so here.

First – Andrew’s letting us into his next reporting outing

Just 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 leave them as comments. (You can do so on this post).

And a little appetizer for us from Andrew.

Getting Treatment for Autism is a Full-Time Job

The research suggests that the greatest chance to improve on the symptoms of autism comes during a brief window in early childhood — but because therapies tend to be labor-intensive and time-intensive, often requiring one-on-one 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?

Andrew Rosenblum is one dedicated reporter. He is out working on his pitch: How Are Bay Area Hospitals Using Music to Treat Neurological Disease? It is an excellent question and Andrew is out searching for answers. If you like the reporting process – chip in to support Andrew’s time and efforts.

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I’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!