There’s something about rhythm

Our bodies work in rhythm...

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Rhythm. Yes, it is all about the rhythm. In music… and in music therapy. If the rhythm is off, everything is off. Read on…

“Rhythm is sound in motion. It is related to the pulse, the heartbeat, the way we breathe. It rises and falls. It takes us into ourselves; it takes us out of ourselves.” - Edward Hirsh

Rhythm. It is the most important element in music. It is the foundation of all music and is essential for creating structure and movement. Rhythm is the magic that holds the music together, the heartbeat that keeps the body of a song alive. And, even though it pains me to say it (being a guitarist), the drummer is the most important part of the band. Why? The drummer keeps the rhythm. When the rhythm is off… well, there is no way to recover.

Music and rhythm are rooted in every known culture. What parent does not use rhythmic rocking to soothe a crying baby? The repetitive sounds and silences that comprise rhythmic patterns make dancing possible, aid in the memory, and facilitate group singing, playing, or drumming. Rhythm has been used for millennia to tie societal members together — the chants of a religious order or the cadence calls of military ranks are just two examples. And there’s poetry and verse, the rhythm of language, circadian rhythms in sleep, and the rhythmic changes of the seasons.

And…

Our bodies work ‘in rhythm’. We walk in rhythm. We breathe in rhythm. Our heart beats in rhythm. And just like in music, if the rhythm is off, everything is off. One of the main reasons music therapy works in helping patients in a hospital setting is rhythm.

Then there’s ‘entrainment’. Entrainment occurs when body rhythms synchronize with the music to produce a desired response. It’s like when you are walking through Target and Stayin’ Alive is playing overhead. Without realizing it, you are soon walking right in sync with the rhythm. (And you may even feel a little like Tony Manero walking through Manhattan on a Saturday night.) A music therapist may use entrainment and rhythm to work on gait issues with a Parkinson’s patient. After assessing and finding the right tempo and song, the patient may soon be walking more steadily with the music, entraining to the rhythm. (And, perhaps also feeling a little like Tony Manero.)

I do a lot of work in critical care in the hospitals where I work as a music therapist. And I work with patients on mechanical ventilation, using music to help reduce their anxiety and pain. Since the patient on the vent cannot speak, (because of the breathing tube inserted in their windpipe) how can we tell if they are anxious? We can look at the rhythms of the body. One indication may be their heart rate. If their heart rate is high, something over 100 bpm, that may be an indication of anxiety or pain. (There are also scales and tools that critical care nurses use to assess pain and anxiety in vented patients.) One way to help reduce their anxiety and pain is to give more medications. But they are usually already quite medicated, with strong sedating drugs. And we know that the more drugs given, the longer it could take to get them off the vent, which can then lead to more long-term issues.

Fortunately, medical teams are now looking at more non-pharmacological means to help their patients… like music therapy. How can music therapy help? Again, using the inherent elements in music to work with the body. Rhythm. Entrainment. When working in this forum, the patient’s heart rate monitor becomes like a metronome (a tool that produces a rhythmic steady beat.) So, when I initiate a music experience to help reduce anxiety, their heart rate is my starting tempo. I match the music’s tempo to their heart rate (and in other cases to their respiratory rate.) Once the music and their heart rate are in sync, or entrained, I will gradually start to decrease the tempo of the music. And oftentimes… the heart rate will follow. Over 30 minutes, give or take, we can often take a heart rate from somewhere over 100 bpm down into the 80s. Entrainment!

The music…

Sometimes I’m just improvising and creating, in the moment, on the guitar. I may even include some light, purposeful tension to start and as the tempo decreases, the tension gradually moves to more soothing and harmonic themes to help prompt a relaxation response. I may also incorporate structured songs if I can find out from family members what the patients’ music preferences are. I’ve used Elvis, Frank Sinatra, Green Day, (adding humming or singing) all working with entrainment and rhythm and heart rate. [Although, I never assume music preferences. If I don’t know, I will stay with improvisation.]

Entrainment and breathing…

We can do the same with breathing. If someone is having breathing issues, they are often anxious, and when we are anxious, we tend to tighten up and our breathing becomes shallower. So… rhythm. Entrainment. Here’s a story of a patient, an older woman, whom I worked with recently:

She was having trouble breathing, trying to find the right position in her hospital bed. She really couldn’t speak more than a few words without losing her breath. She was very anxious. In our initial conversation, when I asked her about music in her life, she told me that she used to sing in the church choir, “…it’s been a long time…” and that she loved the old hymns. “Well then,” I said, “we should sing.” She looked at me with apprehension, “But… I can’t breathe.” I asked her, “What is your favorite hymn?” “In The Garden.” “Okay, just follow me, nice and easy.” I kept the rhythm solid and steady but with an easy feel, and the tempo just a bit slower than her shallow breathing rhythms. And… we sang. Her breathing started to naturally follow the phrasing of the song—the rhythm—and gradually became slower and deeper. [When you sing, you naturally breathe within the rhythm of the music, drawing in breath fully for the next phrase, which opens up your airways. (Yes, singing is great for breath maintenance!) Our breathing ‘entrains’ to the rhythm of the song. And yes, I did purposefully slow the tempo as we went along. And her breathing rhythm followed.] After the song, she recalled a memory of an Easter concert she sang in when she was younger. Then, I asked, “How’s your breathing now?” “Oh… I wasn’t even thinking about it!”

We walk in rhythm. We breathe in rhythm. Our heart beats in rhythm. And if the rhythm is off, everything is off. But fortunately… we have music. (And rhythm… And entrainment…)

“The art of healing, the art of ecstasy, the art of God-consciousness has millions of names in mystic terms. It has to do with rhythm and reality. When the body is in rhythm, there is ease. When the body, or any part of the body goes out of rhythm, there is dis-ease.” – Harbhajan Singh Yogi

The healing power of music… and rhythm.

(*the stories presented in this blog are based on accounts and experiences and are not actual accounts or experiences.)

Raymond Leone, MMT, MT-BC is director of Medical Music Therapy at A Place To Be and the Inova Health System