Music therapy helps stroke survivors regain lost speech by singing

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Ray Hart’s vocabulary consisted of just one word after his August 2022 stroke.

“Yep” was all he could say, said Pamela Jenkins, his caregiver and partner of 24 years.

Like many survivors, Hart, 62, can understand what’s said to him almost as well as he could before the stroke, but it’s still hard for him to form complete sentences.

Now, though, a year after adding music therapy to his rehabilitation schedule, he can sing them.

“I’ve got sunshine on a cloudy day,” he sang during a recent session at Sentara Fort Norfolk Plaza, relief and pride glowing on his face as the pent-up words escaped. “What can make me feel this way? My girl!”

Jenkins urged medical professionals to consider including music therapy in their rehabilitation recommendations as a panelist in Friday’s Stroke Symposium hosted by Sentara in Williamsburg.

“That therapy, we have found, has helped him more than anything else,” she said.

Hart sees Tracy Bowdish, the only music therapist Sentara employs. Bowdish had worked with a task force to help pass music therapy licensure legislation in Virginia in 2020.

Despite its effectiveness for stroke survivors, Parkinson’s and Alzheimer’s patients and others with various types of cognitive deficit, music therapy is generally not covered by insurance, Bowdish said.

To make it accessible, Sentara takes a loss on the program and charges patients a $40 fee for each session. That amount hasn’t increased in Bowdish’s 12 years with the hospital system.

“I’m inherently skeptical by nature, so I know people look at music therapy and think it looks all fluffy,” Bowdish said.

But neurologic music therapy engages various parts of the brain, involving emotion, rhythm, memory and language, she said. When functional magnetic resonance imaging emerged, she added, practitioners thought they’d be able to find where music lives in the brain. It turned out, though, that unlike speech, which is controlled from the brain’s left hemisphere, music shows up all over the place.

“We use more of our brain when we sing than we do when we speak,” she said.

Music therapist Tracy Bowdish works with stroke survivor Ray Hart, 62, and his partner Pamela Jenkins during a session at Sentara Fort Norfolk Plaza in Norfolk on Thursday, May 16, 2024. (Kendall Warner / The Virginian-Pilot)

Dr. Alexander Grunsfeld, Sentara’s medical director for neuroscience and the director of Friday’s conference, said the power of music has always fascinated him.

“Everything else that moves you as a human being, you can correlate that with some value for survival,” Grunsfeld said. From love to fear, there’s a clear relationship, he said, but music doesn’t seem to have the same obvious correlation.

“I’ve always been really curious about that,” he said. “Why is music so powerful?”

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The neurologic reasons music therapy helps after a stroke are a bit easier to understand, he said. A stroke is caused by an interruption of blood flow to the brain, usually triggered by a blood clot. Those clots, in turn, are often caused by damaged blood vessels, Grunsfeld said, adding that significant increases in stroke rates over the past several decades are associated with metabolic syndrome in a Western diet and sedentary lifestyles.

“It’s very difficult to change lifestyle,” he said. “But for people who really don’t want to have a stroke, the best option for them is to eat healthy and to engage in physical activity.”

Since clots usually occur in a limited area, they also cut off blood flow to the brain in a limited area.

“The brain is unlike any other organ in that it cannot last for more than a few minutes without oxygen,” Grunsfeld said. “If the blood was interrupted long enough, the neuron cells will die, and then that part of the brain will no longer be able to function normally.”

Recovery or improvement after a stroke typically depends on other neurons growing new connections to take over the functions of the brain cells that died, he said, but overall understanding of recovery has changed dramatically over the past decade — especially the assumption that recovery is only possible for the first six months after a stroke.

“What we found out is that is not true, and it was a bit of a self-fulfilling prophecy,” Grunsfeld said. “People should know that if anyone tells them that ‘you’re just never going to get better than this,’ that isn’t accurate.”

“The more you use your brain, even as you get older and even after a stroke, your brain has the ability to adapt and to improve,” he said. “And so I would say that recovery or improvement is possible at any stage. You just have to do the hard work.”

Music therapist Tracy Bowdish works with stroke survivor Ray Hart, 62, and his partner Pamela Jenkins during a session at Sentara Fort Norfolk Plaza in Norfolk on May 16. (Kendall Warner / The Virginian-Pilot)

Music therapy can make that work a little less hard, Grunsfeld and Bowdish both said, simply because it’s fun.

“Obviously, we know what we should do,” Bowdish said. “We know we should exercise more. We know we should put down the cigarettes. We know we should do things, but that doesn’t mean we do them.”

The same is true for therapy, she said, which requires both efficacy, meaning the therapy really works, and compliance, meaning the patient actually completes it. It’s hard for someone to keep a frown on their face and sing along glumly with their favorite songs, she said.

Bowdish, who has been completely blind since birth, said the occasional patronizing attitudes she encounters have affected how she treats her patients.

“I don’t ever want to be condescending or have low expectations for people,” she said. “Just because somebody had a stroke, that doesn’t automatically define who they are now.”

“Yeah!” Hart interjected emphatically, paying close attention to Bowdish’s passionate comments.

“Yeah, say it!” Bowdish responded, laughing. “That’s just one day that one thing happened. It definitely changes the rest of your life, but it’s not necessarily a major part of somebody’s identity unless they choose for it to be.”

Courtesy of the Virginia Department of Health

The signs and symptoms of a stroke, from the Virginia Department of Health.

Have a health care or science story, question or concern? Contact Katrina Dix, 757-222-5155, katrina.dix@virginiamedia.com.

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Alzheimer’s drug that can slow disease gets backing from FDA advisers

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WASHINGTON — A closely watched Alzheimer’s drug from Eli Lilly won the backing of federal health advisers on Monday, setting the stage for the treatment’s expected approval for people with mild dementia caused by the brain-robbing disease.

Food and Drug Administration advisers voted unanimously that the drug’s ability to modestly slow the disease outweighs its risks, including side effects like brain swelling and bleeding that will have to be monitored.

“I thought the evidence was very strong in the trial showing the effectiveness of the drug,” said panel member Dean Follmann, a National Institutes of Health statistician.

The FDA will make the final decision on approval later this year. If the agency agrees with the panel’s recommendation, the drug, donanemab, would only be the second Alzheimer’s drug cleared in the U.S. shown to convincingly slow cognitive decline and memory problems due to Alzheimer’s. The FDA approved a similar infused drug, Leqembi, from Japanese drugmaker Eisai last year.

Lilly studied its drug by grouping patients based on their levels of a brain protein, called tau, that predicts severity of cognitive problems. That prompted FDA reviewers to question whether patients might need to be screened via brain scans for tau before getting the drug. But most panelists thought there was enough evidence of the drug’s benefit to prescribe it broadly, without screening for the protein.

“Imposing a requirement for tau imaging is not necessary and would raise serious practical and access concerns to the treatment,” said Dr. Thomas Montine of Stanford University, who chaired the panel and summarized its opinion.

The FDA had been widely expected to approve the drug in March. But instead the agency said it would ask its panel of neurology experts to publicly review the company’s data, an unexpected delay that surprised analysts and investors.

At a high level, Lilly’s results mirrored those of Leqembi, with both medications showing a modest slowing of cognitive problems in patients with early-stage Alzheimer’s. The Indianapolis-based company conducted a 1,700-patient study showing patients who received monthly IV infusions of its drug declined about 35% more slowly than those who got a sham treatment.

But there were differences in the way Lilly tested its drug that raised questions for FDA.

One change was measuring patients’ tau, and excluding patients with very low or no levels of the protein. But panelists said there was enough data from other measures to feel confident that nearly all patients could benefit from the drug, regardless of their levels.

In another key difference, Lilly studied taking patients off its drug when they reached very low levels of amyloid, a sticky brain plaque that’s a contributor to Alzheimer’s.

Lilly scientists suggested stopping treatment is a key advantage for its drug, which could reduce side effects and costs. But FDA staff said Lilly provided little data supporting the optimal time to stop or how quickly patients might need to restart treatment.

Despite those questions, many panelists thought the possibility of stopping doses held promise.

“It’s a huge cost savings for the society, we’re talking about expensive treatment, expensive surveillance,” said Dr. Tanya Simuni of Northwestern University. She and others experts said patients would need to be tracked and tested to see how they fare and if they need to resume treatment.

The main safety issue with donanemab was brain swelling and bleeding, a problem common to all amyloid-targeting drugs.

Three deaths in the donanemab study were linked to the drug, according to the FDA, all involving brain swelling or bleeding. One of the deaths was caused by a stroke, a life-threatening complication that occurs more frequently among Alzheimer’s patients.

FDA’s panel agreed that those the risks could be addressed by warning labels and education for doctors as well as medical scans to identify patients at greater risk of stroke.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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British TV host Dr. Michael Mosley reached millions by being his own guinea pig

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By BRIAN MELLEY and PETROS GIANNAKOURIS (Associated Press)

RHODES, Greece (AP) — Dr. Michael Mosley was his own guinea pig.

In the name of science, the British television host put his body to the test by ingesting tape worms, injecting snake venom and letting leeches suck his blood.

What didn’t kill him made him more popular and he reached millions through BBC programs like “Trust Me, I’m a Doctor,” other appearances on TV and radio, and through bestselling diet books.

In the end, his death came during a hike in the blazing sun on the Greek island where was vacationing.

Greek police said Monday there was no sign of foul play, though an autopsy was underway to find the cause.

Here are some things to know about Mosley:

He was steps away from reaching a beach

Mosley, 67, was found dead Sunday, four days after he went missing on the island of Symi.

His wife said he took the wrong route on what was supposed to be a short walk to the next town and appeared to have collapsed.

The path would have taken him over or alongside a steep unforgiving slope littered with rocks and no shelter from heat that hit 37 Celsius (98.6 Fahrenheit).

His body was found within a few dozen steps of the water.

“He almost managed to reach his destination,” Lefteris Papakalodoukas, the mayor of Symi told Greek Alpha television. “It was only another 10 meters (33 feet) to the beach. But that must be when his strength left him.”

Dr. Clare Bailey Mosley said her family took comfort knowing her husband almost made it to safety.

“He did an incredible climb, took the wrong route and collapsed where he couldn’t be easily seen by the extensive search team,” she said in a statement.

The banker who became a doctor who didn’t practice medicine

After graduating from Oxford University, Mosley became an investment banker before going back to school to become a doctor. After qualifying for a career in medicine, though, he took another dramatic career change. He trained as an assistant producer at the BBC and that eventually led to a profession in front of the camera.

Mosley was widely admired for his ability to communicate complex science clearly and his willingness to be the subject of experiments that made others shudder.

In a BBC program called “Infested! Living with parasites,” he swallowed tapeworm cysts. He used a “pill camera” to explore his insides and was watching on an iPad in an Indian restaurant when he first saw the tapeworms attached to his intestine.

“I shouted out: ‘Blimey! There’s a tapeworm in me!’ The other diners looked very surprised,” he said. “I was delighted, but at the same time, it was rather horrible.”

When he was diagnosed with stage 2 diabetes in 2012, Mosley turned to health science and developed a diet that beat the diagnosis and became the basis for one of his books.

He later popularized intermittent fasting and low-carb meals through his 2013 book “The Fast Diet,” which he co-authored with journalist Mimi Spencer, that proposed the so-called “5:2 diet” to minimize calories two days a week while eating healthily the other five.

His “Just One Thing” radio series launched in 2021 advocated simple changes that could transform health and wellbeing.

“I remember him as a bright spark who although now sadly extinguished, will live on through his influential ‘Just One Thing,’” said Mark Miodownik, a materials science professor at University College London, who had worked with Mosley. “Science has lost one of its best and most influential communicators. His warmth and connection to the audience was remarkable.”

Tireless search from the air, ground and water

The search for Mosley began when he didn’t return after leaving his wife and friends and going for a walk from Agios Nikolaos beach near where he was staying.

Searchers on foot, divers in the water, helicopters and drones from above and parties combing the shore from boats spent four days looking for Mosley.

CCTV footage that was believed to be the last known sighting him had shown him walking through a village with a black umbrella overhead to protect himself from the sun.

But footage released Monday appeared to show him scrambling down a rock slope next to a fence and falling out of view where his body was later found.

On Sunday, a boat with the mayor and a group of journalists was scanning the rugged slope when a cameraman saw something dark among the rocks.

The mayor took a photo of the camera display and zoomed in.

“It has a good resolution,“ he said. “It was the missing man.”

Ilias Tsavaris, a bar manager at the Agia Marina, said he scrambled up the hillside after getting a call from the boat telling him to confirm the sighting.

“When I walked up I saw something like a body,” he said. “You don’t see a dead body everyday, it is not a warzone, it’s summer, you are supposed to have fun and swimming.”

Clare Bailey Mosley thanked the people of Symi for their tireless search for a man they didn’t know.

“Some of these people on the island, who hadn’t even heard of Michael, worked from dawn till dusk unasked,” she said.

___

Melley reported from London. Associated Press writer Costas Kantouris contributed from Thessaloniki, Greece.

Presidential election could decide fate of extra Obamacare subsidies

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Andy Miller | (TNS) KFF Health News

When Cassie Cox ended up in the emergency room in January, the Bainbridge, Georgia, resident was grateful for the Obamacare insurance policy she had recently selected for coverage in 2024.

Cox, 40, qualified for an Affordable Care Act marketplace plan with no monthly premium due to her relatively low income. And after she cut her hand severely, the 35 stitches she received in the ER led to an out-of-pocket expense of about $300, she said.

“I can’t imagine what the ER visit would have cost if I was uninsured,” she said.

Cox is among 1.3 million people enrolled in health coverage this year through the ACA marketplace in Georgia, which has seen a 181% increase in enrollment since 2020.

Many people with low incomes have been drawn to plans offering $0 premiums and low out-of-pocket costs, which have become increasingly common because of the enhanced federal subsidies introduced by President Joe Biden.

Southern states have seen the biggest enrollment bump of any region. Ten of the 15 states that more than doubled their marketplace numbers from 2020 to 2024 are in the South, according to a KFF policy brief. And the five states with the largest increases in enrollment — Texas, Mississippi, Georgia, Tennessee, and South Carolina, all in the South — have yet to expand Medicaid under the Affordable Care Act, driving many residents to the premium-free health plans.

But with the federal incentives introduced by the Biden administration set to expire at the end of 2025, and the possibility of a second Donald Trump presidency, the South could be on track to see a significant dip in ACA enrollment, policy analysts say.

“Georgia and the Southern states generally have lower per-capita income and higher uninsured rates,” said Gideon Lukens, a senior fellow and the director of research and data analysis for the Center on Budget and Policy Priorities, a nonpartisan, Washington, D.C.-based research organization. If the enhanced subsidies go away, he said, the South, especially states that haven’t expanded Medicaid, will likely feel a bigger effect than other states. “There’s no other safety net” for many people losing coverage in non-expansion states, Lukens said.

When Cox was enrolling in Obamacare last fall, she qualified for premium tax credits that were added to two major congressional legislative packages: the American Rescue Plan Act in 2021, and the Inflation Reduction Act in 2022. Those incentives — which gave rise to many plans with no premiums and low out-of-pocket costs — have helped power this year’s record Obamacare enrollment of 21 million. The extra subsidies were added to the already existing subsidies for marketplace coverage.

The states that didn’t expand Medicaid and have high uninsured rates “got most of the free plans,” said Cynthia Cox, a KFF vice president who directs the health policy nonprofit’s program on the ACA. Zero-premium plans existed before the new subsidies, she added, but they generally came with high deductibles that potentially would lead to higher costs for consumers.

A Trump presidency could jeopardize those extra subsidies. Brian Blase, a former Trump administration official who advised him on health care policy, said that eliminating the extra subsidies would bring the marketplace back to the ACA’s original intent.

“It’s not sustainable or wise to have fully taxpayer-subsidized coverage,” said Blase, who is now president of the Paragon Health Institute, a health policy research firm. People would still qualify for discounts, he said, but they wouldn’t be as generous.

Karoline Leavitt, a spokesperson for Trump, did not answer a reporter’s questions on the future of the enhanced subsidies under a new Trump administration. Despite his comments at the end of last year that he is “seriously looking at alternatives” to Obamacare, Leavitt said Trump is not campaigning to terminate the Affordable Care Act.

“He is running to make health care actually affordable, in addition to bringing down inflation, cutting taxes, and reducing regulations to put more money back in the pockets of all Americans,” she said.

While views on Obamacare may be divided, the wide support for subsidies crosses political lines, according to a KFF Health Tracking Poll released in May.

About 7 in 10 voters support the extension of enhanced federal financial assistance for people who purchase ACA marketplace coverage, the poll found. That support included 90% of Democrats, 73% of independents, and 57% of Republicans surveyed.

The enhanced assistance also allowed many people with incomes higher than 400% of the poverty level, or $58,320 for an individual in 2023, to get tax credits for coverage for the first time.

Besides the financial incentives, other reasons cited for the explosion in ACA enrollment include the end of continuous Medicaid coverage protections related to the covid public health emergency. About a year ago, states started redetermining eligibility, known as the “unwinding.”

Roughly one-quarter of those who lost Medicaid coverage moved to the ACA marketplace, said Edwin Park, a research professor at the Georgetown University Center for Children and Families.

In Georgia, Republican political leaders haven’t talked much about the effect of the Biden administration’s premium incentives on enrollment increases.

Instead, Georgia Gov. Brian Kemp, among others, has touted the performance of Georgia Access, an online portal that links consumers directly to the ACA marketplace’s website or to an agent or broker. That agent link can create a more personal connection, said Bryce Rawson, a spokesperson for the state’s insurance department, which runs the portal. Employees from the agency and from consulting firms helped market the no-premium plans throughout the state, he said.

Yet Georgia Access didn’t become fully operational until last fall, during open enrollment for the marketplace. Republicans also credit a reinsurance waiver that, according to Rawson, increased the number of health insurers offering marketplace coverage in the state, leading to more competition.

Reinsurance is likely not a major reason for a state’s increased Obamacare enrollment, said Georgetown’s Park. And a study published in Health Affairs found that Georgia’s reinsurance program had the unintended consequences of increasing the minimum cost of subsidized ACA coverage and reducing enrollment among individuals at a certain income level, the Atlanta Journal-Constitution recently reported.

The state’s insurance department said the study “does not accurately reflect the overall benefits the reinsurance program has brought to Georgia consumers.”

When asked whether the governor would support renewal of the enhanced subsidies, Garrison Douglas, Kemp’s spokesperson, said the matter is up to Congress to decide.

Another reason for the soaring ACA enrollment is the 2023 fix to the “family glitch” that had prevented dependents of workers who were offered unaffordable family coverage by employers from getting marketplace subsidies.

States that have run their own marketplaces, though, generally have not seen the same level of enrollment increases. Those 18 states, plus the District of Columbia, have expanded Medicaid. Georgia will join the list of states running their own exchanges this fall, making it the only state to operate one that has not expanded Medicaid.

The federal Centers for Medicare & Medicaid Services credits a national marketing campaign and more federal funding for navigators, the insurance counselors who provide education about marketplace health coverage and free help with enrollment.

That level of financial support for navigators may be in jeopardy if Trump returns to the White House.

The Biden administration injected nearly $100 million in funding for navigators in the enrollment period for coverage this year. The Trump administration, on the other hand, awarded just $10 million a year for navigators from 2018 to 2020.

The marketplace is usually “a transitional place” for people coming in and out of coverage, KFF’s Cox said. “That marketing and outreach is pretty essential to help people literally navigate the process.”

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.