Music therapy helps patients regain speech lost by strokes, dementia and brain disorders

“It’s nine o’clock on a Saturday” is the opening lyric to Billy Joel’s classic song, “Piano Man,” but little does Raymond Hart know that the lyric holds the answers to two questions he’ll receive when the song comes to an end.

Hart sits in a chair with his eyes looking down at the lyrics typed on a piece of paper inside a three-ring binder resting on his lap.  He taps his left foot to the beat of the music and sings as many words as possible.

Seated across from the 62-year-old is Tracy Bowdish, a music therapist with Sentara Neurology Specialists, who leads the singing exercises while strumming a guitar – pausing periodically to give Hart cues that help him find a word. 

“What time does the first verse take place?” Bowdish asked Hart after the final note. “What day of the week was it?”

Hart, who suffered a severe stroke in August 2022, answered the questions with a bit of help from Bowdish who strummed the first line again to help him speak "nine o'clock" and "Saturday."

“Music therapists use music as a tool to help people reach non-musical goals,” said Bowdish. “We can reach areas of the brain using music and music therapy interventions where traditional therapies may not be able to.”

Hart participates in music therapy in addition to speech and physical therapy for strength and balance training. While the right side of his body is still numb, from head to toe, Hart has made considerable improvement in his speech – from being able to say just two words to dozens of words.

“He can understand everything we are talking about, but all he could really say after his stroke was, ‘yep,’” said Pamela Jenkins, Ray’s partner. “I think his progress is phenomenal.”

Tracey Bowdish (left), a music therapist with Sentara Neurology Specialists, leads a session with stroke patient Raymond Hart.

‘I knew the signs’

Just like every other weekday morning, Hart stopped at the 7-Eleven about a mile from his home on Aug. 15, 2022 to buy coffee, a Mountain Dew and a pack of cigarettes. It was his daily routine before getting on the road to work as a battery technician.

He had just parked at the convenience store when he started having a stroke. He somehow managed to drive back home where Jenkins happened to be in the driveway.

“At first, he looked really scared and I didn’t know what was wrong,” Jenkins recalled. “I asked him to touch his nose, squeeze my hand and to smile. He couldn’t do anything that I asked him to do…I knew the signs from different advertisements you see. I knew he was having a stroke.”

Jenkins quickly drove Hart to the emergency department at Sentara Leigh Hospital. Shortly after, he was airlifted by Nightingale Regional Air Ambulance to Sentara Norfolk General Hospital (SNGH) where he immediately underwent a surgical thrombectomy to remove a blood clot in his brain.

Music helps create new neuropathways in the brain

Hart began speech therapy before he left the hospital in September 2022. Six months later, he added music therapy into his recovery – starting with two sessions per week.

“Music engages the entire brain,” Bowdish explained. “We use more of our brain when we sing than when we speak. We can use music to facilitate neuroplasticity. So we are able to reroute the brain and create new neuropathways to be able to help facilitate that expressive language for people.”

Alexander Grunsfeld, M.D., who serves as medical director of neurosciences for Sentara, believes the service is underutilized and the reason is two-fold: a lot of people don’t know about the benefits and many insurance plans do not cover the cost of a visit.

Sentara Music and Medicine Center does not bill insurance for the music therapy appointments. Instead, Sentara charges a $40 fee per appointment and incurs the remainder of the cost.

Music therapy is beneficial not only for stroke patients but most neurological disorders, including Parkinson’s disease, dementia, traumatic brain injuries and multiple sclerosis. It helps patients cope with their emotions, regain speech and improve memory.

“Even though your speech center might be damaged in your brain, you can still learn how to speak by trying to induce some musicality into what you are trying to say,” said Dr. Grunsfeld. “I think it’s a very valuable modality for therapy.”

Raymond Hart, 62, looks down at song lyrics while singing during a music therapy session at Sentara Neurology Specialists in Norfolk, Va.

Music therapy does not require musical background

Hart always enjoyed singing aloud to rock music in the car, especially songs by the Counting Crows or Third Eye Blind. While he enjoys singing, Bowdish says a love for singing or an interest in music is not required and should not deter people from seeking the therapy. 

“I think there are misconceptions. People come and think they have to be a good singer [however] music is just the tool, the process that I use,” said Bowdish. “We do have a lot of fun, but there is a lot of great neuroscience going on underneath.”

Bowdish, a board-certified music therapist who was born fully blind, does not believe her disability is a barrier to providing high-quality care. Instead, she believes she offers more compassion to patients who want to be seen for more than the medical condition that brought them to therapy.

“I don’t ever want to be condescending or have low expectations of people,” said Bowdish. “Being blind is not a major part of my identity – and the same goes for my patients.”

 

The future is bright

 

After nearly a year in music therapy, Bowdish says Hart has shown improvement with more expression, singing with fewer cues and being able to transition from singing words to speaking words.

Hart, who has enjoyed getting back to yard work and helping with household chores, is determined to keep adding words to his vocabulary and improving his overall health.

“The biggest help for me is that he has such a great attitude,” said Jenkins. “We can do it. We can get through it.”