Healing Measures

By Richard Byrne

Could music hold a key for more effective treatment of illnesses ranging from Alzheimer’s to autism? Collaborators with the new Johns Hopkins Center for Music and Medicine — where musician health is also a focus — are pushing to find out.

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Left to right, Alex Pantelyat, Sarah Hoover, and Serap Bastepe-Gray are key leaders of the new Center for Music and Medicine. Photography by Will Kirk/Homewood Photography

Can singing together help ease the symptoms of Parkinson’s disease? Members of a choir in which some suffer from the disease help answer that question every week at the Harry and Jeanette Weinberg Senior Center at Govans Presbyterian Church in
North Baltimore.

The choir performs under the direction of Leo Wanenchak (BM ’79, Music Education, Piano) and social worker Ellen Talles. Mr. Wanenchak starts exercises for the group that warm up the body and the vocal folds. These activities increase gently in difficulty
and prepare the group for the singing to follow.

Mr. Wanenchak imbues the rehearsals with good-humored encouragement and comic asides. As the group runs through “Jingle Bells” later in the session, he wittily pushes the singers to experiment with different endings to the piece: “You can go home and tell everyone, ‘Today, I did an augmentation in my coda.’”

This project — dubbed “ParkinSonics” — is one of the first fruits of the Johns Hopkins Center for Music and Medicine (CMM), a new interdisciplinary collaboration
between the Peabody Institute and health divisions of Johns Hopkins University. The center aims to gain new insights into how music and rhythm can be used to treat illnesses such as Alzheimer’s disease, Parkinson’s disease, stroke, epilepsy, and autism, and to improve pain control. It also hopes to extend the power of music directly into health care facilities and to provide members of the Peabody community with access to specialized care for injuries that often afflict professional musicians.

The ParkinSonics singers were recruited for a 30-week study conducted by CMM Co-Director Alex Pantelyat, an assistant professor of neurology at the Johns Hopkins University School of Medicine. One group of Parkinson’s patients sang weekly in a chorus. A control group participated in a moderated weekly discussion group. Then, the groups switched midway through the study, which aimed to survey the effects
of singing on voice, mood, memory, and quality of life.

Dr. Pantelyat is still crunching more than 2,500 data points from the study, but he says that the enthusiasm of the patients has been illuminating. “Overwhelmingly,” he observes, “even before the program was over, most participants wanted to continue. And they have continued.”

Funding from the Johns Hopkins Parkinson’s Disease and Movement Disorders Center and the Maryland Association for Parkinson’s Support has allowed the project to carry on past the study. Choir members say the experience has left them feeling stronger and more willing to take on risks and challenges.

Mr. Wanenchak leads a number of choirs and vocal ensembles in the region, including his work as associate conductor of the Baltimore Choral Arts Society and as director of the Junior League of Baltimore’s choral group, the Larks. “Like I told them today: ‘You’re among the most attentive of any singers I have ever conducted,’” he says of his charges. “They are sharp-eyed, and they are really invested in what they are doing.”

The positive effects on the ParkinSonics singers are also abundantly clear to him. “I see very happy faces out there,” adds Mr. Wanenchak. “At the end of the session last year, one of the participants came up to me and said, ‘I never sang before in my life. I was told I was not a singer. Now I sing all the time. You’ve given me an amazing gift.’”

The founders of the Center for Music and Medicine see ParkinSonics — where healthy outcomes meet rigorous science — as a model for future activities. They also see the benefits of a closer relationship between Peabody and the renowned medical community at Johns Hopkins.

CMM Co-Director Sarah Hoover (DMA ’08, Voice) says the new center aligns with the four pillars of Dean Fred Bronstein’s strategic plan for Peabody. The interdisciplinary collaboration — one of the four pillars — is also designed to foster qualities of excellence, innovation, and community connection, which are at the heart of Peabody’s path forward as an institution.

“It’s exciting how much enthusiasm this has been met with on the medicine side,” she observes. “With no exceptions. The overwhelming positive response has been very exciting.”

Since his arrival at Johns Hopkins in 2014, Dr. Pantelyat has been a galvanizing force in creating the center. He has played violin solo in orchestras and ensembles since childhood and eagerly seeks out projects such as ParkinSonics that combine music with medicine.

Initial discussions between Dean Bronstein and Dr. Pantelyat planted the seeds for the center. These conversations envisioned existing partnerships between music and medicine, including work by Peabody faculty member and occupational therapist Serap Bastepe-Gray (BM ’96, MM ’99, Guitar) and Dr. Pantelyat’s colleague Dan Drachman, a professor of neurology at the School of Medicine and a clarinetist, as models for the center’s work.

“Peabody and the School of Medicine already had a history of collaboration,” says Dr. Pantelyat, “but nothing as formal as the CMM.”

Dr. Hoover’s arrival at Peabody in 2015 as special assistant to the dean for innovation, interdisciplinary partnerships, and community initiatives helped clarify the concept. She had previously gained experience combining music and medicine while working as a singing voice specialist in a multidisciplinary voice care team. Her enthusiasm for the project led her to create a Music and Medicine Task Force within Peabody to push forward the proposed center.

The task force recommended that the CMM reach beyond research and build pathways for musicians associated with Peabody to connect with the medical community. Most important for the task force was for Peabody musicians to gain access to specialized care for injuries that often befall musicians, including conditions ranging from repetitive stress disorders to focal dystonia, and for performance faculty artists to gain training in movement science in order to bring technical and musical expertise to the multidisciplinary team.

Dr. Bastepe-Gray — who holds a joint appointment with the Department of Neurology at the Johns Hopkins University School of Medicine — says the need for such efforts is clear. “Epidemiological research within the last 20 years shows that high rates of playing-related musculoskeletal and neurological disorders prevail in musicians, from elite concert performers to amateur players,” she observes. “But musicians’ occupational health has yet to be moved from a boutique niche to a mainstream field that can support a paradigm shift with translational and clinical research in approaches to prevention and rehabilitation.”

Dr. Hoover hopes the center will move this key issue into the foreground of Peabody culture. “We need to create a culture where talking about an injury or pain is embraced and where those conversations have a clear landing point within a coordinated health care system,” she says.

The collaboration will also bring talents of even more Johns Hopkins physicians to the cause. “We knew that putting [our efforts] under the umbrella of a multidisciplinary center,” says Dr. Pantelyat, “and establishing a streamlined assessment, evaluation, and triage of musicians would provide a tremendous and unparalleled service.”

The directors of the CMM are now busily networking within the Johns Hopkins community, recruiting partners and searching for donors. More than 70 Johns Hopkins faculty members across disciplines have endorsed and supported the center’s work — and the list keeps growing.

The power of the strong parallels between the cultures of music and medicine has also been a boon for the collaboration. As one of many Johns Hopkins doctors who play music at an advanced level, Dr. Pantelyat sees “the commitment to excellence” as a strong link between the two cultures at Johns Hopkins.

“There is exactitude,” he continues, “a mathematical certainty that goes along with the rhythm of music.”

Dr. Hoover points to another important parallel between the two cultures. “In medicine,” she observes, “there is a creative and sometimes uncomfortable tension between perfection and precision, on the one hand, and human connection, on the other hand. It parallels a tension between those same two things in musicians. We are actively working to build a new curriculum at Peabody that has our students straddling that tension very actively. We can be a living example of doing that.”

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Peabody student guitarist Julien Xuereb performs at the Springwell Senior Living Community, where he is musician-in-residence. Photography by Will Kirk/Homewood Photography

The Center for Music and Medicine’s mission to connect musicians with health care communities is already under way. In one striking case, a Peabody guitar student’s desire to find greater audiences for his work led to a new program of musicians-in-residence at senior living facilities.

Student Julien Xuereb (MM ’15, Guitar Pedagogy) became involved in Peabody’s Creative Access program as a graduate student, playing guitar at local hospitals. His experience playing at the Springwell Senior Living Community in Mount Washington led to an offer to become a musician-in-residence at the facility. Today, he plays his guitar for residents in a variety of contexts within the community in exchange for living quarters as he pursues his Graduate Performance Diploma.

Mr. Xuereb plays pieces he’s working on for his diploma, as well as his own compositions. He’s also added some George Gershwin and ragtime to his repertoire.

Performing in public spaces “gave a sense to my daily practice,” he says. “I’d wake up in the morning and say, ‘Oh, I know why I’m practicing, because next week I am going to play music for people who really need my music to make their day better.’”

Mr. Xuereb found his experience so fulfilling that he applied for and received a Peabody Dean’s Incentive Grant last year to expand the program. His initiative found a positive response at Broadmead, a retirement community in Cockeysville where harpist and Graduate Performance Diploma candidate Peggy Houng (BM ’14, Harp; KSAS BA ’14, Cognitive Science) plays concerts for residents and opens up her rehearsals for elderly audiences.

Ms. Houng says that her dual interests in music and in cognitive psychology have made her Broadmead experience especially satisfying. “People have known for a long time that music therapy is an effective treatment for a number of medical conditions,” she says. “And what I’ve been doing is just confirming that. Music is such good medicine for these people.”

Mr. Xuereb and Ms. Houng are at the vanguard of work that Dr. Hoover believes is vital to the new center’s success — the role of music in improving the lives of patients and caregivers. She says that the center is already planning a broad expansion of similar projects.

“We’re committed to using music as a therapeutic intervention in a wide variety of circumstances and bringing music as a tool in a toolbox for patient care,” says Dr. Hoover. “How can we embed musicians in different clinical environments to do what they do for the benefit of patients, families, and caregivers — including doctors, nurses, and technicians?”

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Peabody faculty guitarist Zane Foreshee aims to investigate whether guitar lessons could help Parkinson’s patients. Photo courtesy of Zane Foreshee

Broadmead will also be the site of a study created by the Center for Music and Medicine that will focus on the effects that singing has on dementia patients and their caregivers. The “side-by-side singing” study will add more knowledge to a growing body of work on how music can heal.

The research element of the CMM’s work is crucial. Scientific studies are increasingly beginning to show evidence for music’s positive effects on healing, but how those benefits are created or which illnesses are best suited for musical interventions are still open questions.

“My impression is that the science [on music and healing] has lagged behind,” says David Roth, a professor of medicine at the School of Medicine and director of the Center on Aging and Health. “There are not a lot of good scientific studies that have been able to confirm the benefits with a controlled and structured research design.”

Dr. Roth is a member of the research team recently awarded a Johns Hopkins Discovery Award for the upcoming study on singing and dementia patients. Dr. Hoover is a co-principal investigator on the project, along with internal medicine clinical fellow Panagis Galiatsatos, who works at Johns Hopkins Bayview Medical Center.

Forging a relationship with Dr. Galiatsatos demonstrates how the CMM will use projects to advance its mission on multiple fronts. In addition to his role at Johns Hopkins Bayview, Dr. Galiatsatos is also a founder and co-director of Medicine for the Greater Good, a Baltimore-based organization that seeks to close the distance among physicians, health care institutions, and the greater community. (Dr. Galiatsatos has already worked with Ms. Houng on a project called Beats and Breathe that married harp music and asthma education in the community.)

As an organization that strives to bring care directly into communities, Medicine for the Greater Good is a perfect partner for the CMM and also for Peabody’s larger efforts to forge connections to wider audiences. “I see this as a beautiful symphony,” Dr. Galiatsatos observes, “a harmonious approach. We’re being called by what we can do in the 21st century and also recognizing that collectively, we can have more of an impact in medicine and health than we can alone.”

Dr. Bastepe-Gray sees the center’s research program as an extension of her work to bring musicians into the heart of the research effort. “Involvement of expert musicians in the investigative process will facilitate the focus of research in generating new knowledge with immediate practical applications to our occupational health,” she says.

Zane Forshee (MM ’01, GPD ’03, DMA ’11, Guitar), who chairs the guitar program in the Peabody Preparatory and serves on the Conservatory guitar faculty, is one of the musicians actively pursuing that course. He is devising a curriculum for a study on how weekly guitar lessons may help those who suffer from Parkinson’s disease. Dr. Forshee’s study has received a Dean’s Incentive Grant, and he says the process has inspired him to rethink the roots of his own playing.

“I had to figure out how to make the guitar seem foreign to myself,” Dr. Forshee says. “The way I could do that was to flip it. Instead of holding it the standard way with the neck in my left hand, I used the right hand. I broke it down into what are the most basic movements we can do that will make a person feel good as they make a sound. I want the person who comes in the door to feel a sense of success, regardless of what’s going on.”

Dr. Pantelyat sees vast possibilities for the confluence of practice and research in the projects pursued at the new center. “I think we are uniquely positioned at Johns Hopkins to develop the premier program in the United States,” he says. “[We’ve got] world-class research expertise, world-class clinical care capabilities across multiple disciplines, and, of course, Peabody, with its international reputation as a world-class [conservatory].”

The quest for a deeper understanding of how music helps heal bodies and minds excites young musicians whose careers may be shaped by that journey.

Mr. Xuereb points to his experience of watching a Springwell patient who is largely silent fall into conversation with her nurses as he plays guitar for her. “The power that we have with our instrument — it’s a power that changes people,” says Mr. Xuereb. “We know it does, but we don’t yet know how.”