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Research Uses Music To Reach People With Traumatic Brain Injuries

Steven Nelson is one of 10 residents at the Villa Coronado Skilled Nursing facility participating in a study exploring the connection between music and memory.
Megan Wood
Steven Nelson is one of 10 residents at the Villa Coronado Skilled Nursing facility participating in a study exploring the connection between music and memory.
Research Uses Music To Reach People With Traumatic Brain Injuries
Research Uses Music To Reach People With Traumatic Brain Injuries GUEST:Debra Bakerjian, associate adjunct professor, Betty Irene Moore School of Nursing at UC Davis

>>> This is KPBS Mid-Day Edition, I am Maureen Cavanaugh. >>> Science has shown that music has a way of invoking memory. It has been used to help people with dementia reconnect to themselves and their environment. A San Diego nursing home is using music therapy on patients once considered unreachable. They are severely brain damaged and kept alive with machines. Joanne Carrion tells us how music is offering hope where there once was none. >> When I was a little bitty baby -- >> Gloria Hawkins is singing a lullaby to her son Stephen. >> Reporter: Stephen is 44 years old. He was shot five times, and beaten at a nightclub in San Diego in 2011. He has lived at the Villa Coronado skilled nursing facility ever since. >> He is unable to move his body, except for his left hand. He does not speak, he is kept alive with breathing and feeding tubes. >> Hi Stephen, you are so happy today, aren't you? Is it because your mom is here? >> Reporter: Just how conscious he is, how aware he is of his surroundings, or even himself, is unclear. >> You want to listen to your iPod today? Your music? [ Music ] >> Reporter: But something happens when Stephen listens to music. [ Music ] >> Reporter: It makes him smile and columns him, because there have been times when Stephen becomes so agitated, he has fallen out of bed. He is one of 10 Villa Coronado residence with traumatic brain injury. He has been given and iPod as part of a experiment. Researchers want to know if music can replace antipsychotic drugs and restraints for those prone to agitation. >> We were surprised when people began to react immediately. >> Reporter: That is Chris Walker, he runs Villa Coronado. He jumped at the chance to try something new on patients who received little to no therapy. People, who for the most part, lived the remainder of their lives in beds, unable to interact with the world around them. >> It could be a smile, it could be -- they are starting to move, or they start to track, where they begin to react to the music. And, it is those little things that kind of bring back to the person is. And that helps the family members, who have maybe lost to the person is. >> Over 5400 men and women living in 300 nursing homes are taking part in the study, which was designed for people with dementia. Deborah is one of the researchers conducting the study at the school of nursing at UC Davis. >> We are going to try to show an association between the use of the music program, and whether or not it reduces their aggressive behavior, whether they can come off of their antipsychotic medication, -- >> New research suggests using therapy could help recovery for people with, -- A, -- it could even define consciousness. High rates of vegetative patients have been misdiagnosed. That indicates there is more likely a spectrum of consciousness. That is, they drift in and out. Carolingian records is a associate clinical professor in the Department of psychiatry at UCLA. Her work is demonstrated 40-50% error rate in determining consciousness. >> So, have the time you might think that your patient is unconscious, although he is conscious, or he is showing signs of consciousness. This is mind-boggling. It is very challenging. >> Reporter: The impact of misdiagnosis can impact medical treatment and end-of-life decisions. It is especially important when protecting a patient's chance of recovery. >> Ace station -- a patient in a semiconscious state has more of a chance to emerge or get better than a patient in a vegetative state. >> Reporter: In other words, if a patient is sometimes conscious, like Stephen, as opposed to never -- there is hope. >> I know that he is in there. >> Reporter: Stephen's mother believes that her son can hear her. And understand her. >> That is what keeps me going. I know he is in there. >> Reporter: And she is certain that he can hear the music. [ Music ] for KPBS news, I am Joanne Carrion. >>> Joining me via Skype is Deborah Bickerton, and it associate adjunct professor at the Betty Irene Moore school of nursing at UC Davis. And Deborah, welcome to the program. >> Thank you very much Maureen. >> We heard that something happens when some brain injured patients listen to music. Do we know what that something is? Do you think it actually helps heal the brain? >> I don't think we have the right science yet around the healing process, but there is a lot of evidence that there is a responsiveness that happens based on personalized music. And it is interesting. I'm going to be meeting in a couple of weeks with another faculty person here at UC Davis, who has done some other research where they were actually doing some brain scans. So, I am really excited to be able to talk with him, to see if we will be able to do more with our cohort, that are participating in this effort. But, the research says that there is a responsiveness, that music is deeply embedded in our brains, and that people are responding to music that they were familiar with, and that was important to them when they were younger, in particular. When we hear the music, we often can connect it with the actual event we associate that music with. So, whether that was at some important family gathering, or whether that was something that people were doing in school, or a particular dance, or the kinds of social activities that people do. And that linkage from hearing the music, and helping to take people back to that point in time, somewhere within the brain, that is connecting. And we know that some of that from things that some of our patients have told us, who maybe are cognitively impaired. They may be confused and have some level of dementia, but they are able to talk about -- I remember when. Oh, that is when I -- we used to go out dancing all the time. So, we know that there is that connection, even though they may not remember what they had for lunch that day. >> Wow. Now, you say you have heard from people who work at nursing homes in this program, that some unreachable patients just come alive from listening to music. What else can you tell us about how this exposure to music has affected patients? >> Well, anecdotally, and I'm going to preface this comment with the fact that we don't have all of our analyses done. But, in interviewing many of the program managers in the nursing homes who are running these programs, they tell us that they see their residence in the nursing home less agitated and sad. Less withdrawn. They are now more present and do not get as irritable. In some cases, they are able to reduce the amount of medications they are taking. And, for some individual residents, they may even get off their medications. Now again, I want to preface that with -- these are all individualized bits of information we are getting from various people. So, it may not apply to every participant. But, it is significant enough that the nursing homes who are participating in this program are incredibly excited about what this has done to improve the quality of life of the residence and the nursing homes. >> What is the advantage of getting a patient with dementia off antipsychotic medication? What is the benefit of that? >> Well, the main benefit of it is that the antipsychotic medication -- we have found out in the last several years, are associated with some increase risk of mortality, of death. And, this association is found particularly and those individuals who have dementia. So, there has been quite an effort on the part of centers for Medicaid and Medicare services, and then all of the state agencies, as well as the professionals across the nation, to try to reduce the use of antipsychotics and people with dementia. Also, there are some other side effects of these antipsychotics that are really not beneficial either. So, this might be anything from making people somnolent, where they are sleepy all the time and not able to enjoy their surroundings, to other kinds of side effects. So, the goal is that if we can help them with issues around behavior, agitation, irritability, delusions, hallucinations, those kind of things -- for which the medication was given to begin with, if we can do something to substitute for that, they are much better off without those medications. >> I have been speaking with Deborah Bickerton, associate adjunct professor at the Betty Irene Moore school of nursing at UC Davis. And Deborah, thank you so much. >> Thank you Maureen, thank you for having me. [ Music ]

Steven Nelson had decided he wanted to be a nurse. He had spent his teens in trouble and his early 20s in prison. Finally, in his mid-30s, with a steady job as a receptionist in an urgent care and five kids to support, he believed he had found his calling.

"He tried to get his life together,” said Gloria Hawkins, Steven’s mother.

The regret in her voice wells, as Hawkins recalls what had been the happiest moments of her son’s life, cut short by five bullets and a beating to the head at a San Diego nightclub in 2011.

Nelson, now 44, suffered a traumatic brain injury that was so severe he has been kept alive in a nursing home with breathing and feeding tubes for nearly seven years. He is unable to move his body, except for his left hand. He doesn’t speak.

But music may now be offering hope where there once was none, both in Nelson’s quality of life and in his ability to respond to the world around him.

Research Uses Music To Reach People With Traumatic Brain Injuries Part 1

Science has shown music has a way of invoking memory. It’s been used to help people suffering from dementia reconnect to themselves and to their environment. Now, researchers are trying to figure out whether music can be used as therapy for people once considered unreachable.

Nelson is one of 10 residents at the Villa Coronado Skilled Nursing Facility participating in a $1.4 million statewide study that is exploring the connection between memory and music.

“There is neuroscientific evidence that music is very embedded deep in the brain ... and linked to experiences,” said Debra Bakerjian, an associate adjunct professor at the Betty Irene Moore School of Nursing at the University of California Davis.

Debra Bakerjian, an associate adjunct professor at the Betty Irene Moore School of Nursing at UC Davis. She says the choice of music is key.
Megan Wood
Debra Bakerjian, an associate adjunct professor at the Betty Irene Moore School of Nursing at UC Davis. She says the choice of music is key.

Researchers at UC Davis have partnered with the California Association of Health Facilities to determine whether music can replace antipsychotic drugs in nursing home patients who are prone to agitation and help improve their quality of life.

“We’re going to try to show an association between the use of the music program and whether or not it reduces their aggressive behavior. Whether they can come off from their antipsychotic medication, whether they’re at least using it less frequently,”

Bakerjian said.

More than 4,500 men and women living in 300 California nursing homes are taking part in the study, aimed at residents with dementia. Those with traumatic brain injury can also display aggressive behavior, requiring medication and even restraints.

Nelson’s bed is kept low to the floor with a mat below because he has become so agitated he has fallen out of the bed three times. That made him a good candidate for the study, said Christopher Walker, Villa Coronado’s chief operating officer.

“We wanted to see, does it help? Can we use a non-pharmacological intervention to actually reduce some of these things (and) improve their quality of life?” Walker said.

On a Wednesday morning, Vanessa Radilla, an activities worker at the Coronado nursing home, placed headphones on Nelson and clipped an iPod the size of a matchbook onto his hospital gown. It was preloaded with some of his favorite songs and artists: “Stand by Me” and “Amazing Grace,” and 50 Cent and Eminem.

“You wanna listen to your iPod today?” Radilla asked. “Are you gonna dance?”

Research Uses Music To Reach People With Traumatic Brain Injuries Part 2

Nelson, with his mother at his bedside, nodded. He smiled. He lifted his head so the headphones could be adjusted. All of these seem like routine responses but not for Nelson. For him, they were like tiny miracles.

He was first diagnosed as being in a vegetative state as a result of his brain injury. While people in a vegetative state may appear awake and alert, medical experts say they are unaware of themselves or their environment.

inewsource first reported on this population in 2014 in a special series called An Impossible Choice. The stories exposed a largely hidden world of special nursing home units in California, in which more than 4,000 people are kept alive with breathing and feeding tubes.

Recent research suggests music therapy could help with recovery for people in a

coma or in a vegetative state. It may even help diagnose consciousness, which continues to mystify scientists. Studies have consistently shown high rates of misdiagnosis in vegetative patients, indicating there is more likely a spectrum of consciousness where they drift in and out.

“Half the time you might think that your patient is unconscious, although he is conscious or showing signs of consciousness. This is mind-boggling,” said Caroline Schnakers, an associate clinical professor in the Psychiatry Department at UCLA and an assistant director of the Casa Colina Research Institute.

Schnakers’ work has demonstrated a 40 percent to 50 percent error rate in determining consciousness. A misdiagnosis can affect medical treatment and end-of-life decisions, Schnakers said. Getting the diagnosis right is especially important when predicting a patient’s chances of recovery, she said.

“The patient in a minimally conscious state has more chance to emerge or get better than a patient in a vegetative state,” she said.

For Nelson, his condition appears to be improving, but he hasn’t been re-evaluated by a neurologist in four years. His doctor, Ken Warm, has noted Nelson’s improvement in his medical chart. But Warm acknowledged the nursing home, run by the nonprofit Sharp HealthCare, does not have the resources to evaluate residents for consciousness. Most of Villa Coronado’s long-term nursing home patients are covered by Medi-Cal, the state health care program for the poor and disabled.

Ken Warm, Nelson’s doctor at Villa Coronado.
Megan Wood
Ken Warm, Nelson’s doctor at Villa Coronado.

“It’s very clear that he doesn’t fit that (diagnosis), that he is responding to events in his environment which would not be consistent with persistent vegetative state,” Warm said. “There’s so much unknown about their cognitive function and their ability to process language or what recovery they might have in the future.”

The idea of using music in nursing homes took off after the debut in 2014 of the documentary, “Alive Inside: A Story of Music and Memory.” The documentary showcased the work of Dan Cohen, who had been providing iPods to nursing homes since 2006 and is now the executive director of the nonprofit organization, Music and Memory.

The film follows the stories of nursing home residents with dementia who were “reawakened” after listening to songs of their youth. Music and Memory now provides iPods to thousands of nursing homes across the country.

UC Davis researchers plan soon to have initial results from their study. But regardless of whether music is able to replace medication, Bakerjian said she is certain it can improve quality of life.

Gloria Hawkins sitting next to her son at the Villa Coronado Skilled Nursing Facility
Megan Wood
Gloria Hawkins sitting next to her son at the Villa Coronado Skilled Nursing Facility

“I was almost in tears doing this interview with an activities director in a nursing home who was sharing how excited they were at their nursing home about the response of the residents. He told me how they just come alive,” she said.

Walker, the nursing home director at Villa Coronado, has also witnessed a similar change in some of the residents with iPods.

“When you see someone go from non-participating in anything, to all of sudden smiling and nodding their head, and it really seems as though they are reacting to the music that they’re listening to, it’s really amazing,” Walker said.

Gloria Hawkins knows her son, Steven, will never fully recover from his brain injury. But she would like to know whether he is capable of more — especially now as she watches him respond to the music he once loved.

“Sometimes he’s very emotional with it and stuff, like he’ll remember and tears will start coming,” she said. “Or he’s very happy, he‘s laughing. It just seems like his memory, just kinda like soothes it.”

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Research Uses Music To Reach People With Traumatic Brain Injuries
Steven Nelson had decided he wanted to be a nurse. He had spent his teens in trouble and his early 20s in prison. Finally, in his mid-30s, with a steady job as a receptionist in an urgent care and five kids to support, he believed he had found his calling.