It has been two months since the Tucson shooting spree that killed six people and injured 12, including Arizona Rep.Gabrielle Giffords. Now Giffords, who survived a gunshot wound to the left hemisphere of her brain, is finding her voice through song.
"Gabby responds to music because she knows a lot of songs," said Maegan Morrow, Giffords' music therapist and a certified brain injury specialist at TIRR Memorial Hermann Rehabilitation Hospital in Houston.
Since Giffords was transferred to TIRR Jan. 21, reports of her singing "Happy Birthday" for husband Mark Kelly and Don McLean's "American Pie" have signaled what some have called a miraculous recovery.
"The brain can heal itself if you do the right protocol," Morrow said. "It just needs lots of repetition, lots of consistency."
Protocols like music speech stimulation and melodic intonation therapy can help patients with damage to the brain's communication center, like Giffords, learn to speak again.
"It's creating new pathways in the brain," Morrow said. "Language isn't going to work anymore, so we have to go to another area and start singing and create a new pathway for speech."
Music therapy was first recognized as a tool to aid soldiers returning from World War II with brain injuries.
"It was discovered that music was more that a diversion or recreational activity -- it could be incorporated into the overall treatment of an individual," said Al Bumanis, director of communications for the American Music Therapy Association. "It could address non-musical goals in a very unique way -- sometimes coming in through the backdoor where some therapies can't."
Indeed, a person who has suffered an injury due to stroke or trauma may have difficulty speaking but be able to sing.
"Patients can be essentially mute, unable to utter a single word but put on the Beatles' "All You Need is Love" and suddenly patients can sing. Substitute some of the words and now patients are speaking again," said Dr. Michael De Georgia, director of the Centers for Neurocritical Care and Music and Medicine at University Hospitals Case Medical Center. "Music is very powerful."
Evidence supporting a healing role for music in the recovery from brain injury is mounting. But many people remain skeptical, and few insurers will cover it.
"I think the name, 'music therapy,' is a barrier. Most people are like 'what is that?' It sounds childish," Morrow said. "I know that it really works. They're already seeing that healing in Gabby."
Music is very closely linked with language. Some people believe that we may have started to sing before we started to speak, De Georgia said, citing "The Singing Neanderthal: The Origins of Music, Language, Mind and Body," by British archaeologist Steven Mithen.
"In fact, one of the reason we enjoy music (particularly tonal music like Bach, Beethoven) is that it follows clear structural, syntactical rules that we can follow, understand, and anticipate," said De Georgia. "We tend not to enjoy atonal music as much (like Schoenberg) because it is all over the place tonally and structurally. Our brains don't get it."
Music is also linked to brains areas that control memory, emotions, and even movement. "The thing about music is that it's something that's very automatic -- part of our old brain system," Morrow said. "If I play a rhythm, I can affect the rest of the body. The body naturally aligns with a rhythm in the environment."
Despite their similarities, music and language are processed in different parts of the brain: Language in the left hemisphere; and music, generally, in the right one. That's why Giffords can sing. But other forms of "automatic language," such as greetings and prayers, can also be spared, according to Lyn Turkstra, associate professor of communicative disorders at the University of Wisconsin-Madison.
Giffords recently chanted a healing prayer with her rabbi, Stephanie Aaron.
"I was chanting this prayer with her, and I could see she wanted to chant with me. I started chanting the prayer in English instead of Hebrew and we were sort of chanting the prayer together," Aaron said.
Aaron said Giffords got frustrated because she didn't know the prayer.
"I said we just need to relax. She would close her eyes and just breathe. In Hebrew, the word for soul is nephesh -- of the same root as breath, neshamah. Taking a breath gives your soul life."
Aaron said the progress Giffords has made in two months is "quite extraordinary."
"And it really goes hand in hand with the kind of person she is: An extraordinary human being -- brilliant of mind, compassionate of soul."
When she left Giffords to return to Tucson, Aaron said, "Gabby, what do you need to remember to do?"
Giffords replied, "Breathe."