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A Noteworthy Endeavor
Illustration by Carole Hénaff, Photography by Chris Hartlove
“We want to make music and rhythm an integral part of treating illness, And we want to learn more about and implement better treatment for musicians’ illnesses worldwide.”
Watch a video featuring Alexander Pantelyat and others from the Johns Hopkins Center for Music and Medicine.
When assistant professor of neurology Alexander Pantelyat arrived in the United States from Ukraine at the age of 9, music was already in his blood. Having played the violin since the age of 7, he continued his studies in Philadelphia, became a member of the Philadelphia Youth Orchestra and took violin lessons through the Applied Music Program at the University of Pennsylvania.
Pantelyat was drawn to a career in medicine, and he went on to earn his M.D. from Temple University. Yet the aspiring physician never put his violin into mothballs. During his neurology residency, he formed a piano trio with former Penn medical and dental students, and the group (called The Hippocrates Trio) won a prize in a “band slam” held at the university’s homecoming festivities in 2012.
“Violin would have been my vocation, if it were not for medicine,” says Pantelyat.
Now he’s found a new way to combine these interests as the co-director of the Johns Hopkins Center for Music and Medicine—an ambitious new interdisciplinary effort to investigate the powerful connections between music and healing.
“We want to make music and rhythm an integral part of treating illness,” says Pantelyat. “And we want to learn more about and implement better treatment for musicians’ illnesses worldwide.”
The center’s strong collaboration between Johns Hopkins’ health sciences divisions and its Peabody Institute will bring rigorous science to investigations of how music and medicine interact. One goal is to develop and employ better evidence-based interventions involving rhythm and music for a range of conditions, including Alzheimer’s disease, Parkinson’s disease, stroke, epilepsy and autism, as well as for non-neurological conditions. Another key part of the center’s mission is to develop research and clinical care to treat and prevent injuries that often afflict professional musicians.
The creation of the Center for Music and Medicine comes at a time of increasing activity in basic and applied research on human healing and music. It is a movement that is being nurtured at the National Institutes of Health (NIH), where a program called Sound Health has been created in collaboration with the John F. Kennedy Center for the Performing Arts.
“When you look hard at the field of music therapy, the evidence base has been mostly observational, or even anecdotal,” says NIH Director Francis Collins. “Now, with better tools to measure response and imaging methods that teach us what is happening when the brain is exposed to music, it seems like a golden moment.”
Pantelyat, whose work as a neurologist has focused on Parkinson’s disease, began investigating specific ways to link his clinical work and music even before coming to Johns Hopkins in 2014. Parkinson’s impairs not only a patient’s motion and gait, but also can significantly affect speech. Interventions involving music, he has found, “hold the potential to alleviate some of the worst symptoms of Parkinson’s.”
Consider the art of West African rhythmic drumming. While a fellow at Penn, Pantelyat watched an initial 45-minute drumming session, in which patients gathered in a circle, each straddling a traditional goblet-shaped djembe drum, then followed the rhythmic lead of the instructor. Afterward, all the patients reported an improvement in their symptoms. Their tremors seemed to subside. They could walk more easily and were in a better mood. Impressed, Pantelyat mounted a six-week pilot study involving 10 Parkinson’s patients who took drumming lessons twice a week. At the conclusion, all participants reported improvement in their quality of life, according to results he reported in Movement Disorders—Clinical Practice.
While at Penn, he also launched a chorus for patients with Parkinson’s, the ParkinSingers. The goal: to help work muscles that are involved in speech and swallowing.
Pantelyat’s evangelism for exploring the links between music and healing impressed Justin McArthur, director of the Department of Neurology, from the moment he hired him. “When we recruited Alex, I knew very little about music and rhythm-based interventions, and how they could be applied to Parkinson’s disease,” says McArthur. “He took it on himself to educate me.”
McArthur observes that from the neurological perspective, music is foundational. “Music taps into some of the more primitive brain pathways,” he observes. “It’s a little bit like smell.”
Indeed, Collins notes recent studies have determined that the parts of the auditory cortex that respond to music are not exactly the same as those that respond to speech. “That tells you music is pretty important,” he says, “or the brain would not have been shaped this way by evolution.”
While anecdotal evidence linking music and healing are abundant, many of the most important questions remain tantalizingly open: What specific benefits can music create? Which illnesses are best suited for musical interventions?
“We are just now scratching the surface of the mechanisms behind all of this,” says Pantelyat.
His arrival at Johns Hopkins accelerated his desire to explore the connections in a more formal way. He quickly saw the potential to capitalize on and combine Johns Hopkins’ “world-class research expertise and clinical care across multiple disciplines” with work going on at Peabody—“a world-class” conservatory.
Pantelyat proposed the collaboration to Peabody Institute Dean Fred Bronstein in January 2015. He found a strong partner (and co-director) in Sarah Hoover, an alumna of Peabody who had returned to the institute as Bronstein’s special assistant to help develop interdisciplinary partnerships. Hoover says the enthusiasm of researchers at the schools of medicine, nursing and public health has been overwhelming. “Their response to the project has been: ‘How soon can we get this started?’”
Pushing forward on work begun in Philadelphia, Pantelyat developed a new study he called Parkinsonics—a 30-week trial that examined the effects of singing in a weekly chorus on the voice, mood, memory and quality of life for patients suffering from Parkinson’s disease. Participants were split into two groups, with one group singing and a control group participating in a moderated weekly discussion group. Midway through the study, the groups switched activities as the monitoring continued.
The center’s first study concluded in fall 2016, and it produced more than 25,000 data points for analysis. Pantelyat is still working on a paper setting out the results, but he says that one clear takeaway is that participants saw significant improvements in their minimal voice volumes as a result of singing in a chorus.
Why is that important? “Minimal loudness is what’s functionally relevant for communication,” says Pantelyat. “It’s important in everyday conversation for the voice not to drop too low, which is often what limits communication in Parkinson’s disease sufferers.”
Pantelyat hopes already existing research projects will find their way under the center’s umbrella as it grows. For instance, Pantelyat was excited by a symposium held in January as part of NIH’s Sound Health initiative—especially when he discovered that one of the presenters was Xiaoqin Wang, a professor of neuroscience, biomedical engineering and otolaryngology–head and neck surgery at Johns Hopkins.
Working in the university’s Laboratory of Auditory Neurophysiology, Wang studies marmosets to explore how the brain perceives sound. His work has determined that these mammals are the only nonhuman animal that can discern pitch—a discovery that offers a promising and reliable pathway into exploring how humans process sound.
One of the many possible applications of Wang’s research may eventually help improve the cochlear implants used by the profoundly deaf. Currently, these devices often do not allow those who use them to distinguish pitch—which is necessary not only to appreciate music, but also to understand conversations involving multiple participants.
The next wave of studies conducted by the Center for Music and Medicine will broaden and deepen the integration of professional musicians and other collaborators into its medical research.
Hoover, for example, will lead an interdisciplinary team with investigators from the schools of medicine and nursing to examine whether patients and caregivers, singing side by side in organized sessions, can improve quality of life for dementia patients. The study received a 2016 Discovery Award from the university’s Office of the Vice Provost for Research, and it will be conducted by a music team that includes Peabody faculty members who will be working at Broadmead, a retirement community in Cockeysville, Maryland.
Hoover says that “selections from the Great American Songbook” of the ’30s, ’40s and ’50s will form the basis of the repertoire for the study. “The point is to get [those with dementia] engaged and involved, and create an environment in which they feel safe and energized by the activity,” she says.
The potential power of the center’s projects to bring healing into communities has also attracted internal medicine fellow Panagis Galiatsatos, who works at Johns Hopkins Bayview Medical Center, to the effort.
Galiatsatos is also a founder and co-director of Medicine for the Greater Good, a Baltimore-based organization that seeks closer and more productive relationships among physicians, health care institutions and the greater community. As one of the lead investigators on the side-by-side singing study, he sees larger benefits.
“If we create an improvement in a relationship between a patient and a loved one [through the study],” Galiatsatos says, “or we provide a quality toward their life that could never be given by a medicine or a clinic visit by a physician, that’s re-establishing the idea of medicine as a public trust. While we have to know the science, there’s a lot more art in medicine than we acknowledge.”
Pantelyat and Hoover also envision a radical expansion of music’s outreach in Johns Hopkins spaces. The center recently invited Moisès Fernández Via, founding director of Boston University’s Arts | Lab @Med program, which works to integrate the arts within that university’s medical center, to help envision future outreach work at the Center for Music and Medicine.
“People proposed idea after idea,” recalls Hoover.
One idea struck Hoover as particularly fertile. “When the [hospital] shift change happens between day and night, the new staff members come in raring to go, but the patients just want to go to sleep,” she says. “What can we do with music to help everybody understand it’s nighttime? My wheels are turning. Lullabies. There’s all sorts of music written for night.”
As part of its mission, the Center for Music and Medicine is taking keen interest in healthy outcomes for one particular set of patients: musicians.
Musicians are at risk for conditions ranging from repetitive stress disorders to focal dystonia, which can impair effectiveness in playing and, at times, even force retirement from the concert stage.
Finding solutions to musculoskeletal and neurological disorders that often plague professional musicians—who devote thousands of hours to practice and playing—was also a spur for Pantelyat to merge his passion for music into his practice. He says that Two Hands, a 2006 documentary about renowned pianist Leon Fleisher, who holds the Andrew Mellon Chair in Piano at Peabody, was a major influence.
Fleisher suffered for many years from focal dystonia, which left him unable to play with two hands. He battled through the condition for many years, learning the left-handed repertoire for piano and pursuing work in conducting. Treatments with botulinum toxin finally allowed him to make a triumphant return to playing and recording with both hands.
“I was tremendously inspired by that film, which I saw in medical school,” says Pantelyat. He is delighted that Fleisher also agreed to be a member of the center’s advisory board.
Peabody faculty member and occupational therapist Serap Bastepe-Gray, an M.D. who holds an appointment with the Department of Neurology, has spent years working on these issues. She has been an important voice in creating the center and sees the participation of musicians in research as a key to finding answers.
“Current scientific literature on musicians’ occupational health is largely produced by health care professionals,” she says. “Musicians’ work involves non-normative use of the upper body and does not lend itself easily to traditional analysis of work-involved stressors.” Involving expert musicians in the research process will help lead to new findings that have “immediate practical applications to our occupational health,” she says.
Providing access to specialized care—from prevention to treatment—is also a priority. Plans for an on-site clinic to specifically focus on the Peabody community are already underway.
“It will be a place where, if a musician from Peabody or beyond has a problem, they can see us right there,” says Pablo Celnik, director of the Department of Physical Medicine and Rehabilitation. “We will also be able to do treatment in the same place, right at Peabody. In addition, we will do pre-evaluations and baseline assessments, as well as work together with the Peabody Conservatory faculty members, going to their classes to help out with ergonomics and preventable problems.”
For Pantelyat, the chance to make his passion and profession harmonize so effectively at Johns Hopkins is a long-cherished dream. But it was made real by winning the support of key institutional leaders and colleagues—and having the boldness to articulate it.
“When I was interviewing at Hopkins,” Pantelyat recalls, “I spoke with [McArthur] and he asked me, ‘What is your dream job?’ And I went ahead and told him. It was a long shot. But I thought, ‘Nothing ventured, nothing gained.’”
“Alex had a choice between music and medicine,” McArthur says, “and we’re lucky he chose the latter.”
“When you look hard at the field of music therapy, the evidence base has been mostly observational, or even anecdotal. Now, with better tools to measure response and imaging methods that teach us what is happening when the brain is exposed to music, it seems like a golden moment.”
—Francis Collins, director, National Institutes of Health
Peabody harpist Peggy Houng performs for residents at Broadmead, a Maryland retirement community where Hopkins researchers will soon launch a side-by-side singing project to study its impact on dementia patients and their caregivers.