Music for Motor and Impulse Disorders

We see the coercive power of music if it is of excessive volume, or has an overwhelming beat, at rock concerts where thousands of people, as one, may be taken over, engulfed or entrained by the music, just as the beat of war drums can incite extreme martial excitement and solidarity. (There is now, indeed, a whole genre of modern dance music called ‘Trance,’ designed to have such an effect.) Mickey Hart and others have written eloquently of the power of drumming in cultures all over the world, and here it is especially the dynamic power of rhythm that is pre-eminent.

This motor power of rhythm may be especially strong in various forms of motor and impulse disorder—and music can indeed be therapeutic here. Thus, patients with Parkinson’s disease, in whom movements tend to be incontinently fast or slow or sometimes frozen, may overcome these disorders of timing when they are exposed to the regular tempo and rhythm of music. The eminent (and now parkinsonian) composer Lukas Foss, for example, whom I saw recently, may festinate or rocket almost uncontrollably to his piano, but once he is there, can play a Chopin nocturne with exquisite control and timing and grace—only to festinate or freeze once more as soon as the music ends.

Music is profoundly important to those with motor disorders, though the music must be of the ‘right’ kind—suggestive, but not peremptory—or things may go wrong. For one of my deeply parkinsonian post-encephalitic patients, Frances D., music was as powerful as any drug. One minute I would see her compressed, clenched and blocked, or else jerking, ticking and jabbering—like a sort of human time bomb. The next minute, if we played music for her, all of these explosive–obstructive phenomena would disappear, replaced by a blissful ease and flow of movement, as Mrs. D., suddenly freed of her automatisms, would smilingly ‘conduct’ the music, or rise and dance to it. But it was necessary—for her—that the music be legato; for staccato, percussive music might have a bizarre counter-effect, causing her to jump and jerk helplessly with the beat, like a mechanical doll or marionette.

People with Tourette’s syndrome—including many I know who are professional musicians—may become composed, tic-free, when they listen to or perform music; but they may also be driven by certain kinds of music into an uncontrollable ticking that is entrained with the beat.

The stirring or animating power of music entails emotional no less than motor arousal. We turn to music,we need it, because of its ability to move us, to induce feelings and moods, states of mind. Therapeutically, this power can be very striking in people with autism or frontal lobe syndromes, who may otherwise have little access to strong emotional states. And the evocative power of music can also be of immense value in people with Alzheimer’s disease or other dementias, who may have become unable to understand or respond to language, but can still be profoundly moved—and often regain their cognitive focus, at least for a while—when exposed to music, especially familiar music that may evoke for them memories of earlier events, encounters or states of mind that cannot be called up in any other way. Music may bring them back briefly to a time when the world was much richer for them.
SOURCE: Sacks, O. (2006) “Brain” Volume 129, Issue 10
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