Sunday, March 1, 2015

Harry Ballan - Music Therapy and Wernicke's Aphasia

At the Institute for Music and Neurologic Function, we see many cases of Broca's aphasia, in which the patient is unable to speak as a result of a stroke or other event affecting an area of the left hemisphere that's considered necessary for speech. More rarely, we see cases of Wernicke's aphasia, in which a different part of the left hemisphere is affected which prevents the patient from UNDERSTANDING language. Whereas we have had great success teaching Broca's aphasics to speak by recruiting areas of the right hemisphere using a technique called melodic intonation therapy, it is less obvious what is to be done in Wernicke's cases. Wernicke's aphasics seem to be miserable and may scream incessantly. Unfortunately, the institutional approach is often simply to medicate, i.e., sedate them, without addressing the misery. 

We found with this Wernicke's patient that we were able to reach her through an hour and a half of very engaged music therapy on Thursday. She has been calm now for several days and has continued to respond well to music. The screaming has stopped and she seems much more content. This is after only one session and much more work will need to be done. I'm not prepared to draw any general conclusions!

I share this experience because it is the beginning of a new project at the intersection of neuroscience and art and also because I wonder if any of you has had relevant experience with Wernicke's aphasia that you would be willing to share. 

By the way, an interesting implication of the experience I described is that music does communicate differently from speech (we already knew that) even though Wernicke's area is involved in both. The fact that music and speech are understood by similar but different neural mechanisms (a subject we are currently investigating at the Yale Brain Function Lab) opens up therapeutic possibilities with certain categories of difficult-to-reach patients that have not previously been investigated or systematically explored. Siyuan (Siyuan Liu) and I discussed the possibility of using music therapy to try to reach patients with early onset schizophrenia. Perhaps some of the same neural mechanisms that permit communication with a Wernicke's aphasic may be used to reach early onset schizophrenics. 

Written by Harry Ballan


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