When Dr. Lauren Mann suffered a concussion in college, she was juggling a double major and two jobs. No matter what she tried, she couldn't get back to her baseline.
These so-called invisible illnesses, which don’t show up externally, can be frustrating for patients. Well-meaning friends and family can easily dismiss the symptoms, and doctors may say there’s not much they can do.
Mann remembered feeling isolated by a lack of medical support.
“I had horrible ringing in my ears,” she said. “I felt like ‘rest’ was just the overwhelming recommendation.”
Rather than accept the situation, Mann was inspired.
“It really kind of lit a fire,” she said, “that I didn’t think (rest) was good enough.”
“There has to be something to help people feel better, and something they can do long-term to get better,” she thought at the time.
Mann changed one of her majors and got a degree in audiology, and, slowly, her interest in music and brain health sprouted. Now, she’s one of many people across Kansas City looking for ways to use music therapeutically, to treat or provide relief to others with invisible illnesses.
After more than a decade working clinically as an audiologist, Mann is currently working at the University of Kansas Medical Center with concussed patients and people with tinnitus, a phantom ringing for which there is no permanent cure.
In her years of practical experience, she’s seen how music can impact nearly every region of the brain and provide immediate, sometimes lasting, relief. Music can also bring people together, she said, offering social benefits to those who might feel alone.
“We can use it to relax, we can use it to maybe inspire memory,” Mann said. “I think, music, when we engage with each other, we can kind of tap into the people around us and our brain-states, and I think that’s the area I’m trying to explore more.”
And while listening to music recreationally is a big part of many people’s life already — and might even be self-prescribed when a person is in a rut or to overcome some challenge — Mann is looking at things from a purely therapeutic perspective.
More specifically, she’s researching auditory timing, which is crucial to how the brain processes sound, noise intensity, duration and frequency. Tinnitus often stems from maladaptive changes in the brain that shift auditory timing.
“The area I want to explore is: How can we use music to repair auditory timing when it is damaged, when it’s not typical?” she said.
To do that, Mann uses different types of filtered noise and music recorded or performed especially for her studies. She’s hoping to compile evidence that could help make her approach a common practice.
Hearing the brain in the rain
To read the brain waves of her study participants in the AURA Lab, an auditory research wing of the medical center, Mann uses a large blue and red cap that she said makes people look like supervillains. It’s covered in hundreds of small white nodes that are each numbered. It takes a bit of setting up, but the results are highly sensitive.
For testing in the field, Mann uses a smaller tool that looks like a gym headband rigged with four electrodes to measure brain activity.
“We’ve got four (sensors), so we can’t do fine-tuned processing” in the field, Mann said, “but I can definitely tell how relaxed you are, and how much you are concentrating with something like this.”
In a demonstration for KCUR, Mann translated a reporter’s brainwaves into sound, expressed as rainfall. As the reporter calmed their mind and relaxed, the rain became quieter and birds began to chirp.
Then, Mann put them to the test: “What’s eight times six?” she asked.
As the reporter’s mind began to race, the rain picked up quickly.
Once the session ends, the program produces a brain wave report. It shows things like brain activity, heart rate, and even whether the participant was listening to the instructions. For this test, she is looking at alpha and beta waves, which show how relaxed or alert the participant was.
Since increased relaxation can help tinnitus subside, as can improved sleep, finding ways to use music to promote calm is essential.
“Patients are always waiting for a cure, a treatment, a pill — something, medically — to fix their tinnitus,” Mann said. “Music is so therapeutic that I can provide some immediate relief while they wait.”
‘Music is unique’
Elsewhere in the metro, a handful of folks are already implementing more therapeutic musical approaches in medical settings.
Amy Robertson, a music therapist and associate professor at the University of Missouri-Kansas City Conservatory, spends one day a week singing to premature babies at Overland Park Medical Center’s Neonatal Intensive Care Unit, or NICU.
“We’ve been finding that they leave the NICU sooner — like two weeks sooner. They’re gaining weight faster and they’re able to tolerate the environment better,” she said. “Now we’re digging into what is actually happening neurologically.”
Robertson said one theory is that music resets the baby’s ability to handle stress.
UMKC also works with adults who have anxiety or depression, and has a neurologic music therapist who works with patients who have Parkinson’s disease.
In addition to the clinical and research work, Robertson oversees four degree programs for music therapy. Over the course of their study, students become competent with guitar, piano, and voice, before spending 6 months working in a clinical setting like Children’s Mercy.
“The music therapy degree is perfect for individuals who are musicians, but they want to be in health care, they want to help,” she said. “It's a perfect marriage of the two.”
Kristi Hansen, a music therapist and owner of Stepping Stones KC, uses music to support child development. She employs four other music therapists to work with between 20 and 30 kids individually, plus many more in group settings. They also offer classic mom-and-baby social groups.
A lot of her clients have autism, a speech delay, attachment disorder and other behavioral diagnoses.
“Music is unique in that it captures this ancestral part of the brain to work on any specific goal,” she said. “So with children, sometimes that’s very basic, early speech skills.”
Despite increasing awareness of music therapies, Hansen said there are some roadblocks. One is education about the efficacy of the approach. Perhaps the biggest issue is that insurance doesn’t typically cover music therapy.
“There is a lag between effective practices, especially for kids, and what’s being supported at a legal level,” she said.
Navigating the world with music
At the Aura Lab and in clinical work, Mann faces funding challenges, as do most researchers. But she’s hopeful those opportunities will increase as education efforts continue to increase.
In addition to her work with tinnitus patients, she’s also researching musical benefits for concussed patients, whose auditory timing may also be disrupted by the injury.
In this study, which is set to end this spring, Mann has participants clap along to a digital metronome that sounds like a cowbell. So far, 38 people have taken part.
“If your brain is working typically, you can clap along fairly well, even without rhythm. But if you have a brain injury, it can get difficult,” Mann said. “Once you get off beat, it’s hard to recover.”
The method is consistent with practices already employed in clinical settings to treat concussions.
For people who suffer from tinnitus or are suddenly hearing ringing after hitting their head, Mann suggests starting with an auditory test to make sure there’s no inner ear damage or concussion.
If there’s no damage, she said something like pink noise can be helpful in the moment and at a low level overnight, especially when things get overwhelming.
In these types of filtered or colored noise, audio signals are modified to remove certain frequency ranges to elicit certain effects. Pink noise has louder lower frequencies and softer high frequencies, which creates a soothing sound some compare to steady rain. The effect can help improve sleep and mask distractions.
The most common form of filtered noise is white noise, but Mann said that type of sound should be avoided.
“White noise is all sound represented at once, so that’s your TV not getting any tuning,” she said. “In the brain, (which is) wired to keep pitch in order, it lights up the brain much like tinnitus does.”
And while some people find they don’t like listening to filtered noise or music, Mann said it doesn’t much matter from a therapeutic perspective.
“Your brain is uniquely wired for auditory timing,” she said. “It’s uniquely wired to recognize pitch, to recognize temporal order. And we use that information to do more than just listen to music, but navigate our world.”
