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Interview with Concetta Tomaino, Music therapist,
Executive Director / Co-Founder of the Institute of Music and Neurologic Function in NYC.
Interview by Stephanie Kamidian
"Songs and works of music that have personal connections create a strong emotional response [...]. This emotional component is very resilient and remains even when other aspects of cognition have been damaged due to dementia or trauma – both physical or mental"
Concetta Tomaino in the Music Therapy studio at the Institute for Music and Neurologic Function.
About Concetta Tomaino
Dr. Concetta M. Tomaino, D.A., LCAT, MT-BC, is a music therapist in the field of music therapy for individuals suffering the effects of stroke or other brain trauma or are afflicted with such degenerative neurological diseases as Parkinson’s or Alzheimer’s. Tomaino is the executive director and co-founder of the Institute for Music and Neurologic Function.
Could you tell us about yourself, what led you to where you are now? What were the key moments in your career?
I have always been interested in science and music. I attended college as a pre-medical student but heard about the field music therapy. This was in 1974 and the field was still new in the US. I entered the MA degree program in music therapy at New York University in 1976 – the program focused on music psychotherapy. However, my first clinical experiences were with people with Alzheimer’s disease, dementia and cognitive issues related to stroke and brain injury. My background in science made me think beyond psychology to understand the dramatic responses I got from the patients. It led me to look at neuroscience for answers to why music could reach and engage the minds of those who seemed unreachable. There was little or no information about brain science at the time. When I accepted a music therapy position at Beth Abraham Hospital in 1980 I met Dr. Oliver Sacks, the staff neurologist at the time. His interest in music and motor function and my interest in music and memory led us to form a close friendship and collaboration seeking out scientists to help us study music and the brain. This eventually led to the creation of the Institute for Music and Neurologic Function in 1995.
Concetta Tomaino and Oliver Sacks with a patient.
Could you elaborate on the relation between music and memory?
Music is a complex stimulus and engages many levels of brain function for us to process a piece of music. Songs and works of music that have personal connections create a strong emotional response which can be positive or negative depending on the association. This emotional component is very resilient and remains even when other aspects of cognition have been damaged due to dementia or trauma – both physical or mental. Music can also aid in memory consolidation because of the number of brain areas involved in processing the music. This is why it is easier to remember a phone number when it is put to music.
Is there a type of music that has more important therapeutic effects than others? Does it have to be a piece of music patient already know? If so, is there a crucial time in life in which music gets stronger roots into our memory? Are we more likely to remember songs or music without lyrics?
There are some aspects of music that can be generalised – such as a strong rhythmic beat can help coordinate gait in a person with Parkinson’s disease. Slow rhythms can relax while upbeat rhythms energise but, because responses to music are very personal and accrued over a life time, it is difficult to make generalisation on the effects of music.
To stimulate memory recall/recognition the more personal the music the more effective it will be.
From studies of music and memory in persons with dementia, it seems that music from someone’s childhood through early adulthood (early 20’s) are the songs most remembered.
To the question "Are we more likely to remember songs or music without lyrics?" my answer is that it can be either – it is interesting that people recall song lyrics to the music from their youth even when there is cognitive impairment.
You’ve spent many years researching this phenomenon closely in order to develop a protocol that would consistently have positive effects on people suffering from brain trauma and Alzheimer's and Parkinson's disease, could you tell us about this research and your discoveries?
My early research (30+ years ago) was on the use of autobiographical music to engage people with late stage dementia. I think this contributed to an increased understanding of the importance of familiar music in care for those with dementia. I also did research on use of rhythm and singing to aid in the recovery of communication skills in stroke survivors with aphasia.
There are many common features between spoken words and music (especially when we think about poetry, singing and opera), and we have all experienced the powerful recognition mechanisms of others through the perception of their voice; could you explain to us what makes music so unique when it comes to triggering memory?
Because music is the combination of patterns of sound, rhythm, tone, harmony, sequential notes, repetition plus the emotional association it gets encoded on many levels – some conscience and some subconscious. The brain relies on patterns to encode information so the multiplicity of patterns inherent in music enhances the memory store.
Could you explain why music could reach and engage the minds of those who seemed unreachable when the voice of their loved ones do not, even though voice is also a combination of “patterns of sound, rhythm, tone, harmony, sequential notes, repetition plus the emotional association”?
I am not aware of detailed studies that analyse this difference in people with dementia, but music may be better preserved because it engages more neural networks and has bilateral processing. There is also the predictability of the over-learned lyrics plus the historical and emotional associations that further enrich the memory encoding of music. Scientists have shown that there is a difference between linguistic memory and musical memory which has led to some questions of music being encoded differently from language. When a family member speaks to someone with dementia there may be some recognition or signs of familiarity with the sound of the voice because of the tone and pattern – but it’s the comprehension of what is being said that has been damaged. Recalling lyrics to a song is different from comprehending conversational speech.
As Director of the Institute for Music and Neurologic Function (IMNF) and Vice President for Music Therapy at the Beth Abraham Family of Health Services, could you tell us what are your main goals for the coming years?
There are several changes with both myself and the IMNF. In 2015, Beth Abraham Family of Health Services, which became Center Light Health System decided to change its operational focus to only managed care services. I had to find a new location that would be supportive of the IMNFs mission. Last year I started the move to the campus of Wartburg a leader in senior health care. Wartburg has a new outpatient rehabilitation facility where we are studying the effects of rhythm and music on gait in people with Parkinson’s disease and stroke. This has led to collaborations with doctors/researchers in Italy. I and IMNF are linking with local colleges to integrate curriculum with the IMNF to provide advanced training for music therapists.
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