Episode 124 - ​​Rhythm and Recovery: How Music Can Enhance Mobility in Neurological Rehabilitation

Did you know that music can improve our cognitive abilities and even aid rehabilitation for people with neurological conditions?

Recently I had the pleasure of meeting Kirsten Smayda who holds a PhD in Auditory Cognitive Psychology, and we dove into the fascinating intersection of music, psychology, and health. Kirsten works at MedRhythms, and they are using the power of music and technology to redefine what's possible in brain health.

Kirsten discovered the therapeutic potential of music while studying at the University of Texas at Austin. Her research has shown that learning to play an instrument can significantly improve our auditory processing and listening skills, which is particularly relevant in the context of neurological health. Our conversation highlights the role of neurologic music therapy to adress various rehabilitation goals, including improving speech, mobility, and cognitive functions through music-based interventions.

Among other things, Kirsten underlines the importance of community in music-making, suggesting that engaging with others in musical activities can enhance motivation and provide emotional support for individuals facing health challenges.

I think you'll agree that the future of music as a healing tool is exciting and full of potential!

DISCLAIMER
The information in this podcast is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition or treatment.

Links and resources:
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Transcript

Introduction: Hello, I'm your host, Kathy Chester, and welcome to the Move It or Lose It podcast, a podcast about all things that move the mind, body, and soul. The Move It or Lose It podcast is for information, awareness, and inspirational purposes only. I am not a doctor and I don't even play one on TV. So please consult with your doctor before making any medical decisions. The views expressed by advertisers, guests, or contributors are their opinions and not necessarily the views of the Move It or Lose It podcast.
Kathy Chester: Hello, welcome to another week of Move It or Lose It. Today, I'm excited to have my guest, Kirsten. I know I messed it up. And so really excited because in the MS world, music and doing things is becoming a big thing. So really excited to have Kirsten on here because she has a PhD, I'm sorry to get this right, PhD in Auditory Cognitive Psychology Researching Musical Instruments.
Kirsten Smayda: Yes, I studied how learning to play a music instrument can improve our brains from an auditory perspective, so especially our listening abilities. Yeah.
Kathy Chester: So that research that you did, what year was that? When did you start that?
Kirsten Smayda: Let's see. So I actually did a master's of music before that at the same school, the university of Texas at Austin. I started that in 2011, right after college. And then that sort of funneled me into my PhD in the same department, which I started in 2013, finished in December of 2017. And that was in Austin, Texas. Yep. Okay.
Kathy Chester: We got a lot of Texans listening. So welcome. So You did the music stuff. What drew you to want to go into that psychology portion of it?
Kirsten Smayda: Yeah, I guess backing up, I, you know, when I was a kid, I really wanted to be a musician, in particular, a singer. And I was really excited about that. And as I was getting into college time, it was suggested to me by my parents to look at other degrees. Like a backup? A backup. and so I started to learn about psychology. I think I had a few friends in high school that were in AP psychology or something and I was like oh this is like the study of people and how why people do what they do and around the same time that I was getting into college the book This is Your Brain on Music by Daniel Levitin and music Ophelia were becoming more and more present in our sphere. And so I was making these connections on campus and college going from music classes to psychology classes. And I just became so fascinated with first understanding how musicians can do what they do from a psychological perspective. But then realizing the therapeutic potential of music, that just put me on a trajectory that I have never wanted to get off of.
Kathy Chester: I understand that because I'm so passionate about what I do. When that fire's lit, it's just there. And it's like, it doesn't go. And I often get asked that, like, you've been doing it for so long. Do you get tired of it? I'm like, never. I just love it. So how did you get the idea? Did you talk to different people who actually did music and ask them, how does this relax you?
Kirsten Smayda: Yeah, so at first I was trying to find a master's program to get into it because I knew I wanted to learn more and sort of get into this intersection between music and health. And there weren't a lot of programs that existed in academia around music and psychology or music and health. And so I called outreach to a bunch of different labs to sort of understand their perspective and how they're studying it. And through that process, I learned you could focus on purely the memorization or the playing of music and like even how sleep impacts your learning and consolidation, you could focus on the impact of listening to music from a mood perspective, you know, making you feel happier, sadder, you know, some people listen to music to induce sadness and sort of like feel that connection. And then I learned about the therapeutic potential of it from learning to play an instrument, where you're not only playing, you're not only listening, but you are potentially reading music, you are playing with other people. And that complexity really started to frame it as a really cognitively rich experience. In a way, it's an exercise for the brain, just like going for a walk or something is for your muscles.
Kathy Chester: I love that. The thing, there's so many cognitive exercises now that, you know, whether it's art or whether it's exercise, things like that, that it wasn't ever talked about. And even when I was trying to find the connection between mind and body and muscle and body, there wasn't. It was like this, like maybe two minute thing that didn't even make sense. And so it was very difficult to get into at the time. And so I love the way you just went for it and just kept calling, saying like, help me. You found something. they can actually get into a program.
Kirsten Smayda: Yeah, so in my PhD, one of my professors had just gotten to University of Texas and he had come from a lab at Northwestern that is very big in the music neuroscience world. At the same time, that professor was starting a collaboration with a professor in the psychology department to basically... transfer some visual decision making tasks into the auditory domain and sort of see if the neural correlates and systems that we use when we're doing a visual decision making tasks hold up in the auditory domain. And so very non therapeutic very basic sort of mechanistic. That was sort of one shift and then I started to become interested in aging, healthy aging and how we can help ourselves and around this time is when Lumosity was getting into some challenges around the claims that they were making and I thought that it was such a Shame because here I am reading literature on what impacts the brain and how we can improve the brain and it's just not getting out there like people who are building products are are not connected to the science. And so those were sort of two streams and then this third stream of the impact of music on our hearing. came into my purview in this degree. And there had been a lot of neuroscience at basic levels of how learning to play a music instrument primes our brain to decipher sound in a more advanced way than if you don't have music experience. and that got me going on like okay we can use music to help our brains in hearing it's using the brain how else can we use music to improve other aspects of the brain and because learning to play an instrument requires so much of the brain so many different networks there's a whole lot of opportunity to use that overlap to then improve the other functions that those brain regions are responsible for.
Kathy Chester: It's so interesting because right now I'm thinking I would be purified to try to learn how to, I had never played an instrument. I mean, and when I was a kid, but my kids all knew, like my daughter plays the guitar and my son plays the piano. And I really wanted them to because I never did. And I just thinking like, oh my gosh, like I can't imagine that. So do people get afraid when you say like, would you like to learn? Are people like, no, I don't think I want to.
Kirsten Smayda: Well, there's definitely a prevailing sentiment that like someone is too old to learn how to play an instrument. And that is just totally incorrect. I do not subscribe to that approach. neuroplasticity is a natural part of our brain. And so if you can find something that is engaging and rewarding, but is also challenging for the brain, that's the intersection that you're looking for. And I think that learning to play a music instrument is a really great intersection because For instance, if you go up to a piano and you press one key, you've made a note. And it can be very accessible when you consider the right instrument for you. And some people have limited mobility in their upper extremities. So thinking about other instruments is one way to do it. But that challenge is not something to be deterred by in my mind. It's just like a physical exercise.
Kathy Chester: I think it's a great thing because, you know, you're wanting to have you to bleed with all the stuff you struggle with and gosh, the whole human race now. But I think it's so important because it is something that, as you said, no one's too old to do. A lot of times I'll have a client that is like 70 to go like, is it too late for me to exercise? I'm like, it's never too late to move your body. And it's never too late to me, even though I might be nervous, but the excitement, the challenge of this is going to help me cognitively. Yeah. Just one of the aspects is a big thing. So talk to me about like your first person that you saw that you kind of connected together.
Kirsten Smayda: Ah, let's see. So I will say the work that I do now is not as much around learning to play an instrument as it is using the rhythm of music to help us walk better. I'll give a preface. I work for the company called MedRhythms. We have our first product out on the market, which is called InTandem, and it is indicated to improve walking and ambulation in folks with chronic stroke walking impairments. So it's focused on the chronic stroke space, but there is tons of literature of the benefits of the intervention that is supporting our product being used in MS and all kinds of neurological diseases and injuries.
Kathy Chester: I was going to ask you that because so often what I do with my stroke patients, I'll do with my MS. And so I I figured that across the line.
Kirsten Smayda: Yeah, the intervention is called rhythmic auditory stimulation or it's sometimes called auditory queuing, and I'll give my perspective from myself not speaking for the company here, but you know when we hear an external rhythmic stimulus our body naturally wants to move to it. And this is happening deep down in the brain, in the really old parts of the brain where automaticity can come from as well. And so when we think about a rhythmic activity like walking, you know, left, right, left, right, that's disrupted when you have a neurological disease and injury. But that doesn't mean that there aren't other routes to create that movement. And so by using an external stimulus like music or a metronome, we can help prime the brain and the body to facilitate all of those little movements that we need to do to make up a walking experience. Right. I love that. Yeah, and it's hard to get people to get out and walk just on a normal day, but let alone with a neurological disease or injury. Sure. You know, there's there's a lot working against someone in those cases. So something that's engaging, that is motivating, but it can also be challenging, is a sweet spot for improving the brain.
Kathy Chester: For sure. Absolutely. I love that idea. And especially the idea that it does connect that and that you can use it and the rhythm. I find it fascinating because I just had my first grand baby. And even so tiny, tiny everything I find, if I do a rhythm, she'll, she loves it. And so it's interesting to me from infancy on up, rhythms have always been something as a mom and, you know, working with kids, I find they adapt to that, but it just always has been something I've loved doing teaching. The love that you're incorporating that with. Like, and even playing it, I'm like, wow, I didn't even think about that part. So what are you finding with the rhythmic? What have the guitars to stroke patients? What have you found?
Kirsten Smayda: Yeah, we have publications on this. So, you know, if you're interested, I'm happy to share links to the scientific explorations of these phenomena. But one of the first things that I noticed that surprised me when working with stroke patients and really other patient groups as well is just the gratefulness of the work that we're doing. For a lot of folks, not only is this a novel concept, but they've been told that there aren't options for them to get better. And so just the fact that there's a company thinking about this sort of thing in a new way still takes me a moment to wrap my head around because that's just the healthcare system we're working with here.
Kathy Chester: Yeah, you're preaching to the choir right now.
Kirsten Smayda: And, you know, that that's obviously very motivating for us to be working with as well. But then, this idea that something like rhythm something so accessible to us on an everyday basis could be used in a therapeutic way. You see it slowly settling in once someone is using rhythmic auditory stimulation and they're experiencing the feeling of being able to walk in a rhythm that they haven't been able to in a long time. So they feel it. And like, it's just so exciting to see the dots connect because we move implicitly when we hear music, but you don't really think about it. And certainly you don't think about it as part of your, your treatment. Exactly. So that reframing of what therapy can be with music is really exciting along with the clinical outcomes of being able to walk better.
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Kathy Chester: So let's say now we're not using it for walking. So we're using it with someone who is wheelchair-bound or something like that.
Kirsten Smayda: Yeah. So depending on the goals of the patient, there is a field called neurologic music therapy. And at MedRhythms, we actually have a therapy division of clinicians that deliver neurologic music therapy. And there are protocols and interventions developed in that field that can target different things can target upper mobility can target speech can target cognition. And so there's a whole field of neurologic music therapy that connects the dots between what needs to happen in the brain and how to facilitate it with music. let's see, wheelchair bound and they wanted to work on reaching, for instance, you know, you could turn that into a rhythmic experience. You're not always reaching forward, back, forward, back the way you would be with walking, but you can create sounds that you experience when you approximate that movement or you get closer to achieving that movement. And I know that there are protocols, so I won't speak for the neurologic music therapist, but there are ways to do that for other movements like that. In speech, singing is a big way to facilitate speaking experiences. So singing lines that you want to practice and then slowly interweaving that into speech is another way.
Kathy Chester: Has the data shown that people that are struggling with speech, once they've been able to use the music, has that been able to help their speech?
Kirsten Smayda: I would have to go back to the literature to see exactly how they tested it to understand what you need to do to get a certain speech outcome. But the overlapping regions of the brain for hearing something and then using your mouth and lungs and diaphragm to coordinate sound out, that's overlapping between singing and speaking. It's really a difference of the tone, the amount of breath you need, and the cadence. Singing, actually takes longer usually to get through a phrase than speaking. And so you could play with that temporal aspect to get someone to sort of speak in a certain cadence.
Kathy Chester: Yeah. No, there's just so many ideas that like get me excited and think in all the ways that you could use this. So you're working with like stroke patients, you're starting to work with MS. What are some of the other autoimmune or what are the areas that you see yourself or the company going and moving into?
Kirsten Smayda: This can be found on our website, but for instance, in our pipeline, we have a product for Parkinson's disease and walking. And the same way that a physical therapist would treat walking for someone with MS differently than stroke, different than PD, so too will we tune our algorithm to look for certain patterns in the data and then make different decisions on the music. So for instance, in stroke, we are interested to help facilitate faster speeds because after a stroke, someone's speed really decreases. You know, when we're observing someone's gait, we can increase the tempo of the music. And because of those subconscious connections between the motor system and the auditory system, we can actually help them draw to walk faster without them really trying hard. And, you know, we're sort of paving the way with the rhythm for them to walk like that. So in MS, for instance, we might think about what kind of algorithm we would develop to work with fatigue that someone experiences. And you know, the age range of folks with MS is different from stroke. And so considering, you know, where they are just from an age perspective is another way to tailor it. And so you could think about the different ways a physical therapist would work with someone's gait and just figuring out how to create an algorithm with music. Yeah.
Kathy Chester: How do you take a patient and decide what instruments they're going to play?
Kirsten Smayda: Yeah. So I'm putting on my neurologic music therapy hat, which I don't have a hat for this. I'm just relying on my understanding of the literature and our therapy team. But if a clinician wanted to work with a patient and use a music instrument to help someone in a certain way, you'd first have to think about what they could use. Can they use their feet? Can they use their hands? You probably also want to think about what their goal is. So if you need to work on strength, maybe working towards an instrument that requires a little bit more strength. So accessibility is definitely something to consider. I know that clinicians will use smaller guitars or things you can hold like maracas or cymbals. there's probably also, you know, what does the patient want to use?
Kathy Chester: So that's so fascinating. It's just very exciting to me. Are you still thinking like, why is there not more research?
Kirsten Smayda: So I gotta be honest, I take a maybe this is a hot take, but I believe that there is a good amount of evidence out there already. I think that we have almost enough research on some uses of music that we need more groups that are trying to translate and get products and services out to people. Because even if we don't know to the cellular level what is happening with music, if it's working and we can reliably put it into a protocol and test that protocol, I think that's the way we need to lean. I think we need to lean more towards translating to real world scenarios because the way a lot of researchers test the impact of music is in a lab in a very structured way. And to think about having a successful product out on the market or a service, you need to do research in those settings. that's a huge disconnect that I see that needs to be bridged more so than more research.
Kathy Chester: You're saying kind of they're not like for like if the new medication comes out for us we'll have like trials so we'll have a bunch of you know patients that will go into that study so you're feeling like there's not enough people that are being used so that we can understand in like trial studies and things like that.
Kirsten Smayda: Yeah, you know, trial studies with the intention of translation into a real product. Because if these great ideas stay in academia, that's not going to help as many people as I think could be helped from this. And so planning out those studies so that you can go to the FDA or whatever route you want to take to market the product, you have to really think about the end experience and how that person is going to use it in the real world. So that translation, I hope I will see it be built out a bit more so that we get all of this really great research into the hands of people who need it and it becomes more mainstream as a therapeutic modality.
Kathy Chester: For sure. Yeah, because I mean, I've heard a lot of ours and I've heard the music, but I don't have a lot of patients that are involved with anybody in it. You know, we have a doctor or someone that they can go to to help them. Anything that we're talking about, you know, they haven't done that. And so I think this is going to spark a lot of interest. And then they're going to be like, OK, where do I go? What do I do? Yeah. And so I think that that is the big thing is if people wanted to, where would you advise them to connect?
Kirsten Smayda: I would probably look for local opportunities, local choirs, you know, singing, it can be more accessible for some people than even playing an instrument. So looking for choirs that are welcoming new folks is one way to go about it. If you're interested in private lessons to sort of get off the ground, I would look for folks who teach beginner adults. Oftentimes, you know, they're focused on children as beginners, but there are more and more folks who offer adult beginner classes. And so I would say, look for the community because if you can get a foot in the community, you can figure out what your opportunities are nearby and create a new habit or, you know, skill hobby with the community too, that, you know, for sure, community is everything for these kinds of things. Yeah.
Kathy Chester: I can't even see like in support groups. You know, being talked about that, you know that learning how to do this, but then as a group, you know, then showing like this is what I decided to do. I'm using it. But what an interesting way to do it so that it's not like everybody's alone. I'm trying to do this on their own. Even though like the support groups, you're from Texas to Michigan, everybody's everywhere. Because there's something with, you know, there's that loneliness when you've got an autoimmune disease or you have a stroke that kind of sets you away from other people and you feel like, I just want to stay in. But when you have a bunch of people that are trying to do the same thing with you, I would imagine that would go better.
Kirsten Smayda: Yeah. And you know, not just to help with motivation, but you're going to get more out of the music making experience when you can relate to the person sitting next to you and you can talk to them afterwards or like lean over when you miss a note and like have that bonding. So for sure. Yeah. The social aspect of music making is this like invisible thing that really just helps sort of boost in my mind, what benefit you could reap from music.
Kathy Chester: I think that's awesome. So you started doing a study, you're in there now, what do you see yourself doing the next like five years? Where do you see yourself in this whole area?
Kirsten Smayda: That's a great question. Well, I hope in five years prescription music products like the ones at MedRhythms are more mainstream and it's just more people are aware of it and more people are learning the vocabulary around how to talk about music as a medicinal sort of thing. So I hope to continue this train and this bridge of getting evidence-based music interventions out into the world. You know, it's a passion of mine to make this research available and turn it into something that can help people. So hopefully I'll be doing something similar just a little bit further along and with a bigger impact because it's so untapped of a modality and I'm very passionate about cognition and sort of memory and looking at behavior from a brain perspective. So it would be interesting to see what sort of the next avenue, you know, if we have a walking rehabilitation product, what's the next most evidence-based music thing that can be available? So... Absolutely.
Kathy Chester: Those always excite me, like something else to help with that, rather than more medicine, more medicine. Oh, we have a great idea for you. More posts. We always embrace when companies come up with ideas that seem like, okay, this is something I could do and enjoy, and it will help. For people like us, looking at someone like you, who took such a passion in trying to connect the dots of this, I'm in awe of those things, and I'm always appreciative of having people on like yourself, and they're taking so much time, and have such a passion to learn things like this. that um really make our life easier and get us really thinking like you've got me thinking like what instrument would I want to play?
Kirsten Smayda: It's like what do I want to do? Do you have an instrument that you've wanted to play? No, I don't.
Kathy Chester: I'm thinking like probably for me it would be something like I don't know like it would have to be a guitar or the drums or something. Okay. It'd probably be something like that. Yeah. I think too for like what you said I think the fingers and that mobility and stuff I think it's really is really helpful. I love that, and I love the cognition part that you're talking about. And I think it's really important, especially for patients, to understand that when we feel like we've lost something, there's a way around. It's not just that one way.
Kirsten Smayda: Yeah, there's redundancy in the brain for good reason. And you sort of just need to find that other door to get through that, that outcome. But I totally relate to your thought around more non pill based interventions. I do believe that there's a place for pharmacological solutions. And even using both together, I know, you know, it's supposed to be better than either one. But there just aren't enough options to keep up with you know, the pharma industry. And so I'm very proud to be a part of that movement.
Kathy Chester: And we're very grateful for it because we get hit with the pharma stuff all the time. And it's like giving something else and it gets exhausting for us to do research. So that's part of why I love doing these because it's like, look, listen, there are things. don't get so disbursed of our thing.
Kirsten Smayda: You don't need to always add more things to the glass. So I was doing some research on MS recently and non-pharmacological solutions, and I came across grounding and earthing. Have you ever heard of these concepts?
Kathy Chester: Yeah, I've heard that. And I was like, actually, it was by someone who said, check this out for a podcast. And I haven't yet checked it out. And I was like, oh, interesting.
Kirsten Smayda: I'm just trying to learn about it as well, because it seems like such an accessible general health improvement. But there's extra focus for folks who have autoimmune disease challenges that I'm very interested to keep learning on that.
Kathy Chester: I'm going to have to look that up, because now I'm excited. I'm going to have to go back in my email. But it is. Those are the things that if more patients could understand, then I feel like it would be such a relief and it wouldn't be so depressing. You know, a lot of times when I'm talking with patients and doctors, there's just this kind of hovering depression and loneliness and isolation where I think If we could do more things like that, there's not that isolation. It kind of takes the piece of that away.
Kirsten Smayda: Yeah. So I think that's really important. Yeah. And music's a great way to do that. I just for sure. Yeah. There are even theories that music developed in humans before speech. and using music as one of the first forms of empathetic communication and alignment on a path. So it could be even more important than we think of now. Wow.
Kathy Chester: Well, Kirsten, I love what you're doing. I am so excited to hear more. So we've got to catch up. And I know that my support crew is going to be like, wait, we want her in. So be ready for that. But I think it's just fascinating. And I think of all the things that you're going to be able to accomplish in five years. In five years, I'll have you, you'll be like, you'll be a rock star in this. Oh, well, thank you. Thank you for doing all this research and just being able to find things to help us. It's very exciting to think about that. And I'm going to go figure out what I want to play. And I'll email you what instrument it is.
Kirsten Smayda: I can't wait to hear it. That makes me so happy. That'll make my day.
Kathy Chester: And I think I'm going to have to challenge my own support groups.
Kirsten Smayda: There we go. Yes. It's not just like the recorder anymore. You can pick up whatever you want.
Kathy Chester: That's what I was thinking while in third grade I had a recorder. Tell us all the ways. to get a hold of Kirsten on LinkedIn and on your website, correct? Yep, perfect. Okay, so I'll have that at the bottom of the show notes, don't forget. And that way you can get a hold of her if you'd like to.
Kirsten Smayda: So Kirsten, I love meeting you. You too, Kathy. Thank you so much for having me on this. Absolutely.
Kathy Chester: You are just a gem and what an exciting thing you're doing. It really has made my day to think about how many things are out there that this could be.
Kirsten Smayda: I'm really excited. It'll be a good future. I'm excited.
Outro: Thank you so much for joining me for another episode of the Move It or Lose It podcast. It would mean the world to me if you subscribed and left a review. Remember, you can find me on Apple, Spotify, and YouTube. New episodes of the Move It or Lose It podcast air every other Wednesday. If you have any suggestions for future guests or topics, please visit my website at www.msdisrupted.com. Until next time.