For Naresh Shanbhag, recovery started with a beat.
In 2023, a stroke left the 53-year-old sales professional in Bengaluru unable to speak words, let alone sentences. “I began physical therapy to regain strength in my paralyzed right side, but forming sentences or remembering the right words was hard for me,” he says.
When a doctor friend suggested music therapy, Shanbhag says he was skeptical. “From the very first session, I was hooked,” he says.
At India’s first music cognition lab at Bengaluru’s National Institute of Mental Health and Neurosciences, or NIMHANS, he was given simple rhythms and beats to emulate. “I started with single beats, and as I got better, was able to tap out more complex beats on a smartphone app,” he recalls. “For the first time since my stroke, I felt a sense of achievement at every new task I mastered.”
When his therapist noticed he could sing more fluently than he could talk, he asked Shanbhag to sing sentences. “One year later, I still do this,” he laughs. “Every morning when I go to fetch milk and groceries, my shopping list is a song that I belt out!”
Shanbhag’s speech is still halting, but he and his wife believe the sessions accelerated his progress.
The lab is run by Shantala Hegde, a professor of neuropsychology and a trained classical vocalist. She and her team of researcher-collaborators and PhD scholars provide rehabilitation services to dozens of patients each month who have brain injuries like Shanbhag’s, at a little over $42 US for 20 sessions.
“I’m in a government hospital, so our charges are very, very minimal,” she laughs. “In private settings, of course, this would cost 10 times or more.”
Hegde says the team has helped patients regain functional speech, coordination and independence in daily tasks. Some, like Shanbhag, have recovered enough to manage everyday life.
“Music is a powerful tool for neuropsychological rehabilitation because you engage the entire brain to engage with it,” Hegde says.
She says the gains do not come from simply listening to music. “We give them specific musical exercises that engage the entire brain, activate different brain areas and strengthen the connections between them,” Hegde clarifies. “The type of music is immaterial, although in Bengaluru, we often use Indian music to make it more engaging for our patients.”
At the centre of the therapy is the brain’s plasticity, the idea that undamaged parts of the brain can rewire to compensate for tissue affected by trauma.
Music-based neuropsychological rehabilitation is now used as an evidence-based, non-invasive and non-pharmacological method to recover brain function after stroke and other brain injuries. One of the most commonly used approaches is rhythmic auditory stimulation, in which musical rhythm acts as an external cue to help patients modulate movement. The method has been found effective in helping patients with stroke and Parkinson’s disease walk better, faster and with better balance.
Rhythm also helps the brain organize actions in time, including coordinated steps while walking and the flow of speech. Patterns, repetition and melody can also make information easier to store and recall.
At NIMHANS, Shanbhag signed up for 40 one-hour music-based neuropsychological rehabilitation sessions alongside his physiotherapy. “Over time, I began to use beats and tunes to speak sentences,” he says.
During the sessions, he practiced replicating rhythms, notes and pitches.
Hegde says treatment starts with an assessment of each patient’s overall condition. The potential for success depends on “the severity of [brain] damage, the amount of time the patient has had the condition and their cognitive reserves,” she says.
She says cognitive reserve reflects how actively a patient was using different parts of their brain before a stroke or injury. Social connections, emotional relationships, educational level and activity levels are among the factors she considers in deciding if a patient is likely to benefit.
“In some cases, the benefits come almost right away. If the patient has a mild brain injury, within a couple of weeks [of music therapy], you’ll start seeing changes,” Hegde says.
Shanbhag completed his 40 sessions over a year. He is now able to speak coherent sentences, has started to walk better and has begun an Instagram page to post music videos.
But wider use of music therapy still faces obstacles. Some randomized control trials have shown only moderate impact, and Hegde says training has been slow in India.
She says protocols and conditions need to be standardized. “As a clinician, if I have 100 cases, I can see what has improved, what’s working,” she says. “But from a research point of view, each of these cases may have different clinical background, different inclusion, exclusion criteria, etc.”
Hegde says there are about 70 music therapy practitioners in India. “We need more trained people in the field,” she says. “That’s for sure.”
She also says pop science has affected the field’s credibility. “So many musicians armed with some online certification programs are calling themselves music therapists today,” Hegde says. “But music therapy requires proper training and standardized, evidence-backed protocols.”
Meanwhile, Shanbhag says he has found a way to keep speaking. “Every morning when I go to fetch milk and groceries, my shopping list is a song that I belt out!”
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