Jazz Walia is a third-year undergraduate student in the Bachelor of Health Sciences (BHSc) program at McMaster University. During the 2023 winter academic semester, she participated in the Room 217 Research Practicum course generously funded by FAVDTR and wrote this blog post as part of her coursework. When I was in my first year of university, just before my first undergraduate assessment, our professor’s only piece of advice was: “Just put on some Mozart 30 minutes before and you’ll be grand.” I initially thought the advice was completely random, but I was convinced it was a hint for a question or even bonus points. Not so shockingly, there were no Mozart questions on the test, but I did end up typing “Mozart” on Spotify 30 minutes before our test and listening to the first classical music playlist I saw. Two years later, my Spotify and YouTube recommendations are filled with playlists called “Calming Music for 12 Hours” or “Classical Test Music.” Music has always provided me with great comfort; however, it is the soft melodic tones of classical music that have transformed my "pre-test ritual." For me, this type of music has always had a calming effect on me whenever I feel stressed, but especially when it comes to mitigating performance anxiety. A quick search on the internet will yield you thousands of results of people searching for the same thing—"calming music"—on various streaming services. Millions of people listen to the likes of Mozart , Bach , Chopin , etc., on platforms such as YouTube and Spotify, begging the question: why exactly does it work? Over the past couple of decades, research into music listening has inspired further exploration into the use of music as an intervention for reducing anxiety. In a recent survey by the Centre for Addiction and Mental Health (CAMH), 25.1% of survey participants expressed feeling moderate to severe anxiety. In addition, 24.0% of Canadians indicated needing some sort of mental health services but were unable to access them, highlighting the need for accessible services and systems. It’s estimated that only 20% of people experiencing anxiety receive formal interventions , illustrating the need for evidence-based resources. Previous research suggests that music can have a significant effect on endocrine function and autonomic activity, enhancing parasympathetic activities—your body’s "rest and relaxation" state—and reducing respiratory rate and heart rate. In a study by Ubmrello et al ., featuring about 960 critically ill patients, 15 to 60 minutes of music therapy were shown to have a significant effect on reducing anxiety and stress. In a recent review of 21 studies conducted by Harney et al., it was discovered that listening to music had an overall large effect on reducing anxiety. This study was the first of its kind and highlights that while we can see a link between music listening and anxiety, more research needs to be done into important aspects such as music selection, length, setting, and dosage when looking into this relationship. Even if you’re not a fan of the classics, both "fast" and "slow" music have been shown to improve mood. In a study by Darki et al. , 98% of fast music listeners and 99% of slow music listeners reported that music helped manage stress. The study also showed that listening to slow music decreased heart rate and both systolic and diastolic blood pressure . Fast music, on the other hand, increases heart rate and both systolic and diastolic blood pressure. Fast music was seen as "uplifting," while slow music was seen as "calming." These feelings of calmness when listening to slow music help showcase why it might be helpful to listen to music in an anxious state. Of course, "slow" music isn’t restricted to just the classics, which arguably can be "fast" at times, but rather music that often features a relaxed pace, a slower tempo, and a simple, repetitive rhythm and melody. Our relationship with music is extremely subjective and unique to our own experiences. It has been shown that music has profound effects on both our physical and mental health; it can serve as a significant non-pharmacological resource to help mitigate anxiety and stress. The internet—most notably YouTube, Spotify, and Apple Music—is filled with playlists specifically for mood. Music and video streaming websites are a great place to start when selecting music that works for you and exploring different genres and playlists! Author’s note: Spotify , YouTube , and Apple Music are audio streaming services that can be accessed through the internet or through cellular devices. Creating an account is free and on YouTube, an account is not needed to listen to music.

Parkinson’s disease is a progressive disorder that is caused by degeneration of nerve cells in a part of the brain called the substantia nigra, which is responsible for controlling movement. It’s the most common movement-related brain disease, affecting approximately 1% of people 60 years and over worldwide (AANS, 2023). When you hear Parkinson’s disease, what comes to mind? Most people will think of slowed movements (bradykinesia), tremors and rigidity, a stooped posture and shuffling (or festinating) walking pattern. But did you know that Parkinson’s disease heavily impacts the voice? Approximately 90% of people with Parkinson’s disease experience something called dysarthria (Moya-Galé, 2019). Dysarthria refers to a group of motor speech disorders characterized by weakness, slowness or poor coordination of the speech muscles. It is referred to as an execution disorder because the weakened speech muscles result in consistent speech errors. Signs of dysarthria might include an inability to speak loudly, abnormal speech rhythm, a strained, raspy or nasal sound voice, monotonous speech, difficulty moving the tongue and facial muscles, slow and/or slurred speech and rapid speech that is difficult to understand. While there are seven types of dysarthria, hypokinetic and hyperkinetic dysarthria are most commonly associated with Parkinson’s Disease. Hypokinetic dysarthria is marked by difficulty initiating speech, rigidity, short rushes of speech, a harsh of breathy sound, monopitch and monoloudness. In contrast, hyperkinetic dysarthria is marked by difficulty inhibiting speech, irregular articulation, emotions and facial expressions, as well as tremor, dystonia (involuntary muscle contraction) and tics. With all dysarthrias, the main concern is intelligibility of speech. Did you know that music therapy can be used to treat symptoms of dysarthria? In Neurologic Music Therapy, there are two main techniques I have used when working with client’s with Parkinson’s Disease. The first technique is Rhythmic Speech Cueing (RSC). In RSC, the rate of speech is controlled via auditory rhythm (Thaut & Hoemberg, 2016, p. 151). By practicing speech to a metronome the temporal characteristics of speech, such as fluency, rate of speech and intelligibility improve. The beat of the metronome is determined by assessing the client’s fluency and rate of speech. From here, functional sentences can be practiced. For example, if working on metric cueing, each syllable would be matched to one beat of the metronome (“I – want – a – glass – of – wa – ter”). The second technique is Vocal Intonation Therapy (VIT). In VIT, vocal exercises are used to maintain and rehabilitate aspects of voice control such as inflection, pitch, breath control, timbre and dynamics (Thaut & Hoemberg, 2016, p. 179). These exercises are similar to those used in vocal warm up. Another concern among those with Parkinson’s disease is monoloudness and reduced loudness because it can be difficult to communicate with others if they cannot hear you. A music therapist might use an exercise that has the client crescendo their voice to practice singing more loudly, and then transfer this skill to speaking. With the prevalence of Parkinson’s disease it is important to think about all aspects of the disorder – especially the voice – because it allows us to communicate with one another. In persons with Parkinson’s disease, singing can then be used as an effective tool for maintaining vocal function in an engaging and motivating way.

According to the Heart and Stroke Foundation, stroke is the leading cause of disability in adults in Canada. The annual occurrence rate has increased to 108,707 which equates to approximately one stroke every five minutes. With the rapidly aging population in Canada, the prevalence of stroke is only expected to increase. And with that, a growing need for strong stroke care. With stroke, one of the most common side effects is impaired speech. Some stroke survivors may experience dysarthria (muscle control difficulties), apraxia (muscle coordination difficulties) or aphasia. Aphasia is a language disorder that can result in difficulties with speaking, reading, writing and understanding speech, depending on the type of aphasia. Research indicates that aphasia occurs in 25-50% of individuals post-stroke. While there are several types of aphasia, we’re going to focus on Broca’s aphasia. Sometimes referred to as an expressive or non-fluent aphasia, Broca’s aphasia is characterized by diminished speech output. Persons with Broca’s aphasia may be able to comprehend speech but have difficulty producing speech. So how does music come into play? Melodic Intonation Therapy (MIT) uses the melodic and rhythmic elements of singing words and phrases to aid in speech recovery. This technique is used with patients who have aphasia. Several studies have indicated that the Neurologic Music Therapy technique MIT can help reroute speech pathways from the damaged left hemisphere to the language-capable regions of the right hemisphere (Thaut & Hoemberg, 2016, p. 141). In MIT the therapist begins with humming, then singing and gradually moves into speaking. The therapist may employ a vocal technique called sprechgesang. In sprechgesang, the therapist uses their voice in an expressive manner, halfway between singing and speaking. Throughout the exercise, the therapist also taps the client’s left hand. Why the left hand? MIT can help reroute speech from the left to the right hemisphere. This is because our brain is organized contralaterally. This means when we tap our left hand we are activating the right side of our brain! Research by Gentilucci and Dalla Volta (2008) also indicates that left hand tapping activates right hemispheric language networks. You may have even heard of MIT in the news before. Congresswoman Gabby Giffords suffered a traumatic brain injury, and was diagnosed with aphasia. MIT was part of her journey to recovering her ability to speak. This is just one way music can be used in speech rehabilitation. It can be difficult to watch a loved one experience the loss of their ability to speak. The beauty of music is that it can aid in rehabilitating the voice while encouraging meaningful moments of connection with others.

You could say it was happenstance or just the music doing its job. It was through performing at an outdoor concert in Toronto that the door opened for me to experience performing music in a healthcare setting. I was heard by the Music Programmer at Sunnybrook Hospital and I have been honoured to play for the Veterans and their families at Sunnybrook in their Warriors Hall, in the gardens and on some of the wards for the more vulnerable residents for over 10 years. In those spaces, up close, I watched the power of music do its work - with all of us - moving our bodies and our hearts. There’s a kind of “musicking” that has a circular, reciprocal effect where people can somehow manage to meet in the space between, song by song and note by note. I don’t think you can do as many of these types of gigs as I have over the years without your heart naturally being wedged open further to a place of deeper empathy. After watching the wonderful care given by the staff at Sunnybrook Hospital, my wife Mary Ellen and I found ourselves as full-time carers for her Mom across a 6 year journey with her struggle with dementia. For my wife, the load was at times very heavy with challenges and demands always changing. I became very aware of the heavy load that people in those kinds of care situations carry - the risk of burn out and feeling invisible, sometimes to the person they are caring for with dementia. And of course, there are the complexities of care when it is such an intimate mother-daughter relationship. But my wife also discovered that this crucible offered up precious moments of intimacy and connection that ironically were only possible because of her Mom’s changing mental landscape. And of course, care extends out to everyone in the home. I did my bit to support them, in part as the “big tease” with my Scottish sense of humour. But I was also able to connect with and encourage my mother-in-law Ruth through her relationship to music. She had been a singer and piano player all her life and previously, I had helped her fulfill her passion by recording two albums for her – one of her favourite Gospel songs and another of her favourite Jazz tunes - which have been great companions for her. As the dementia progressed, we continued to encourage her to play piano for us, well into her nineties, which was a blessing for all of us but also great exercise for her cognitively and physically. At times, I would play boogie woogie piano to help her persevere with her walking routine as the body made it more and more difficult. As a lifelong songwriter, my radar is always on high alert - for fragments of lyrics and music that can be heard in the ether, or simply in conversation. One day, after a performance at the Sunnybrook Hospital, I was having a conversation with a staff member. A line in the conversation stuck with me. The staff member had said to me, “if only I could have put a little bit of my feet in her shoes.” That’s all it took for me to have my songwriting wheels start turning. The melody was mapped out during my drive home and a song began to be born. Songs are funny things. It can take a while before you see fully what you’ve written and what it means to you. I knew I was writing about expressing empathy for someone who was struggling. But I’ve since realized all the places I have seen where empathy is needed – empathy for my mother-in-law, empathy for my wife as her carer and empathy for all the professional carers in different health settings - the brave care warriors who need to be cheered on and reminded that it is OK to ask for help. The song ended up winning the 2022 Mississauga Summer Song Contest and was recorded at Metalworks Studio in Mississauga, produced by myself and Justin Abedin (Jacksoul/Justin Hines) who also plays electric guitar and features an all-star cast of musicians, including Lyle Molzan (Jann Arden), Mark McIntyre (Dean Brody), Joel Visentin (Barbra Lica), Bryden Baird (Feist) and Sean O’ Connor (NOJO). It is the first single from my upcoming album, “One Ray Of Light At A Time.” A SHAREABLE MOBILE e(Empathy)CARD I hope this song will encourage listeners to think of people in their life who could use some understanding and a helping hand. One way they can do that will be by sending “Feet In Your Shoes” with a customizable Mobile e(Empathy)Card to someone you want to let know you’re thinking of them and to offer up some love and support at www.davidleask.com/ecards You can listen to “Feet In Your Shoes” at www.davidleask.com/feetinyourshoes David Leask is a born song-chaser with seven critically-acclaimed albums and multiple international songwriting awards. He also loves to inspire other creators as a songwriting mentor and facilitator.

While certain sights and sounds can remind us of beautiful times, they can also remind us of difficult times, transporting us to a place that we don’t wish to be. Post-traumatic stress disorder or PTSD occurs when someone experiences or witnesses a traumatic event and struggles to recover from it. PTSD can affect someone’s emotional, physical, social and spiritual well-being. Although we often associate PTSD with combat veterans, individuals at any age who experience natural disasters, war, violence, historical trauma and even bullying can suffer from PTSD. It's important to know that PTSD is different for everyone. For some PTSD might look like reliving the event through flashbacks and nightmares, while for others it might look like increased emotional distress. PTSD can result in reactive responses to ordinary sounds, as well as isolation from others and avoidance of daily activities for fear of reliving the traumatic event. So how does music come into play? Music is linked to our emotions, whether negative or positive, it has the ability to bring our memories back to life. Think of how playing a song from the past can help an individual with dementia remember memories that are otherwise forgotten. A concept called state-dependent memory can help us explain why. State-dependent memory occurs when material encoded in a particular state is better remembered if the same state is experienced at recall. This applies to both positively and negatively emotionally charged memories. For someone with PTSD, if a specific sound or song mimics that of the traumatic event, it can prompt them to relive it. The part of our brain responsible for our emotional memories is the amygdala. If someone with PTSD experiences a trigger similar to the traumatic event, it can send a signal through their body to activate their fight-or-flight response. The special thing about music is that it can also be used to override the traumatic event and tap into an individual’s positive memories. Music associated with positive memories can then be used to refocus attention and calm the nervous system. Research shows that guided music listening can help regulate emotions, reduce symptoms of PTSD and increase connections among others, especially if in a group. This can help someone with PTSD increase control over their physiological stress symptoms by creating reassuring experiences that encourage trust in oneself and others. Music can also train the brain to increase tolerance to sounds. For example, responding to different musical cues with a triggering sound in the background helps to work on diverting one’s attention and increasing tolerance to triggering sounds.  Whether it be to relax, distract or transport, music can be used to effectively improve the quality of life for individuals living with PTSD.