After three strokes, Jenni Moore is still keeping a beat and a smile.
In an AdventHealth Central Florida neurology wing, Moore was jamming away on a xylophone with the hospital’s developing program “Strokestra,” an ensemble of musicians and stroke patients making music to encourage positive healing.
“It's a wonderful thing for patients and really anybody that's involved, and certainly the musicians as well,” Moore said.
The program is led by the Dr. Phillips Center for the Performing Arts in Orlando, in partnership with AdventHealth and the London-based Royal Philharmonic Orchestra. Strokestra began in Hull, England, 10 years ago.
“There's a lot of people, stroke survivors, up in that region of the U.K., and out of that came Strokestra,” said Tim Steiner, Strokestra’s creator and director. “Music has an effect on your body and your brain, an incredibly intense effect. It's a participatory project meaning that we invite everyone actually to take part in playing instruments.”
The Dr. Phillips Center saw an opportunity to expand the program in Orlando. Currently, Steiner leads the workshops assisting with the development of Strokestra for the needs of Central Florida.
The region has seen a steady rise in stroke patients over the past eight years, increasing from 3,000 to more than 4,000 in 2022, the most recent year for which data is available on the state’s archive. Even taking into account the growing population, the rate of stroke diagnosis in hospitals still crept up 12%.
Since 2010, Orange County has seen a 23% increase in stroke deaths.
Music and healing
In 2012, Moore was diagnosed with Ehlers-Danlos Syndrome, a rare genetic disorder that leaves hosts vulnerable to strokes. Having endured three strokes, Moore lost her ability to walk. It would be a difficult blow for anybody, but Moore was a dancer.
“I had danced my whole life,” Moore said. “ I've had a crazy medical journey. I've had eight brain and spine surgeries. I've actually been in five rehabs.”
One day at AdventHealth, a nurse who knew of Moore’s previous dance life told her about a musical group meeting just a couple of floors below.
Curious, Moore decided to go to Strokestra. She’s glad she did.
Musicians armed with trumpets, flutes, drums and saxophones began playing songs. Patients were encouraged to keep the beat using maracas, tiny drums and sometimes a xylophone.
The song: the Queen hit “Another One Bites the Dust.”
“Who doesn’t love Freddy?” Moore said of the late Freddy Mercury, Queen’s former frontman.
Moore loved the session so much that she went back the next day, wearing her favorite Beatles shirt, which inspired the group to play a Fab Four favorite, “Blackbird.”
“Music is amazing. It can move your soul in ways that really nothing else can. It can match your mood or it can change your mood. It can get to your soul, can speak to your soul, it can just be something that you have fun with,” Moore said.
Participants all have different degrees of neurological damage. Those with severe neurological injuries are encouraged to join along however they can.
“We’ve had some participants with very limited movement in their hands, but they too can participate,” Steiner said. “It might be you're just resting your hand on the drum and moving a little bit and getting a little bit of vibration, but because of the music going around, you’re engaging in that sound and engaging in that music and getting a physical benefit.”
Tuning Up Neurons for Stroke Recovery
The Dr. Phillips Center’s Strokestra is focused on music’s ability to uplift the spirit, but music can have a neurological healing effect, too, according to experts.
“There are some healing properties of music,” said Anna Galloway, a music therapist at the University of Florida. ”Music can be very powerful in helping the brain to heal and recover and also helping the brain to rewire itself during its neuroplasticity stages.”
Neuroplasticity is a process in which the brain develops new neurons from stem cells to begin healing itself.
“Normally after neurological injury, you have about three months where neuroplasticity is at its peak. And then once you hit about the six-month time period, you start to plateau,” Galloway said. “With new neurons, the brain is able to create new pathways, which means people could regain mobility.”
There are two types of strokes: ischemic, which is a clot that prevents blood flow in the brain, and hemorrhagic, which is a burst blood vessel or artery in the brain. In both cases, parts of the brain can be damaged leaving it unable to carry out bodily functions.
After the damage is done, neuroplasticity begins. Music can stimulate neurological transmitters, like dopamine, which in turn stimulate the production of neurons.
According to a 2022 study published in the National Library of Medicine, music therapy is effective because of how music is bilaterally processed in the brain. The left hemisphere is responsible for understanding lyrics and distinguishing rhythms, while the right deals with melody. Music therapy can take advantage of this. If stroke damage was done to one hemisphere, therapists could use a song that was important to the patient as a form of treatment and build new neurological pathways from one hemisphere to the damaged one.
“It's kind of a new detour through the brain path,” Galloway said.
The study found that traumatic brain injury patients who received three months of neurological music therapy intervention showed enhanced executive functions and fine-grained neuroanatomical changes to damaged areas in the prefrontal cortex.
Galloway has had patients with damage to the speech part of their brain practice singing a song from their past. The melodious part of the brain is able to access the memory of the lyrics, which in turn helps neurons create new pathways to the speech centers. With work, patients can restore their ability to speak.
The therapy has shown satisfying results in healing motor functions, too, said Dr. Kiminobu Sugaya, a neurologist at the University of Central Florida.
“Our brain has a lot of ability to compensate,” he said. “You're listening to the music, and then you’re understanding the music. Then you try to express that understanding with your body movement. So then all the language centers are being used, and then the motor cortex is in use, too. You use so many parts of the brain when you’re listening, or even moving your body to music.”
Strokestra in Central Florida
Moore is working on her walking with the help of music. She started doing it before learning of Strokestra and is working with music therapists through a practice called rhythmic auditory stimulation. Patients are told to match the beat of the music (or in some cases a metronome) with their own movements – in Moore’s case, she matches her steps.
“I walk to the beat of the music, and the beat of the music will change and get quicker,” Moore said. “It's helped me walk again.”
What’s assisted that practice has been her elevated mood due to Strokestra.
The AdventHealth team and Dr. Phillips Center are still developing the Strokestra program. There may be a neurological focus down the road, but for now, the team is focused on how music can elevate a patient’s mood, which in turn can improve recovery rates, said Alana Jackson, the director of arts and wellness at the Dr. Phillips Center.
Another aspect of stroke recovery includes reclaiming a sense of self and having to deal with lost abilities. Jackson hopes that Strokestra will inspire patients to rediscover themselves or find new value in themselves after enduring whatever a stroke has taken from them.
“If we can bring or infuse the arts or music into that space, not only can people have the opportunity to kind of get back to a sense of self, but also rediscover and, you know, new aspects of themselves that they maybe didn't know existed before,” Jackson said.
For Moore, it’s about reconnecting with a love for music. As a result, the Strokestra program has become one of her favorite healing exercises.
“It really touched the soul,” she said.
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