If Gabby Giffords still struggles to speak, how can she sing?
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Yes, Gabrielle Giffords jumped out of an airplane this morning. But that wasn't the only remarkable part of her appearance on this morning's TODAY.
At the end of her sit-down interview with Savannah Guthrie, the former congresswoman from Arizona sang two full lines of "Tomorrow" from the musical "Annie" — this, after an interview in which it was clear she still struggles with her speech, only getting out about one or two words at a time. If speaking full sentences is still difficult, how can she sing so clearly?
It seems mysterious to most of us, but neurologists say there are decades of documented cases of people with Giffords' type of brain damage, who struggle to speak words but can easily sing them.
“The simplest way to explain it is the left hemisphere is very specialized for speaking. And the right hemisphere is more specialized for carrying a tune,” says Dr. David Caplan, professor of neurology at Massachussetts General Hospital in Boston. Three years ago, when Giffords and 18 others were shot at the Tucson shopping center, the bullet that ripped through her skull ravaged her brain's left hemisphere. “And it seems to have affected her language, which is not surprising. But it left her right hemisphere relatively undamaged. And that’s what seems to be supporting the singing.
“To a layman, this might seem surprising, but I think even a layman can understand that language and music are very different in lots of ways,” he continues. “Music itself doesn’t convey information about particular objects in the world … Music conveys some kind of emotion.”
Giffords' struggle with speech is called non-fluent aphasia, says Elizabeth Hoover, clinical director of the Aphasia Resource Center at Boston University. Aphasia is a disorder caused by damage to the brain regions that control language, and it can make speaking, reading and writing difficult. About one million people suffer from some form of aphasia, Hoover says.
But people with aphasia, who have lost so much of their access to language, can often sing – particularly, they can sing songs that they learned prior to the brain damage.
“We have many clients who really can’t say a single word in terms of conversation, but they can sing ‘Happy Birthday,' ‘Take Me Out to the Ball Game’ and so forth,” says Hoover.
It’s because the melody and the long-ago memorized words to those songs are housed in the right hemisphere of the brain, so they're accessible to people with damaged left hemispheres, who do still struggle with putting new, original thoughts into words. This also helps explain Giffords' ability to make her speech on gun violence in front of Congress last year — the speech was likely memorized, so she could access it with the non-damaged half of her brain, says Gottfried Schlaug, a neurologist at Beth Israel Deaconess Medical Center and Harvard Medical School.
But singing a favorite song here and there is so much more than a neat little party trick for patients with aphasia. There is some emerging evidence that these patients can use singing to relearn to speak.
For the last three years, Schlaug has been conducting a trial of melodic intonation therapy at Beth Israel Deaconess Medical Center. (Giffords has used music as part of her speech therapy, but has not been a part of Schlaug's trial.) Here's how it works: He'll sing a phrase to a patient and ask her to sing it back. For example, the phrase, "It is Thursday," set to the melody of the first few notes of "Twinkle, Twinkle, Little Star." They'll practice this for a while, and when the patient has that down, he'll use the phrase again — not singing this time, but using heavy intonation, making the voice go up and down on each syllable: "IT is THURSday." After some time practicing this, he'll ask the patient to say the phrase normally: "It is Thursday."
This whole process can take days or weeks, depending on the patient, and after they've gotten it down, they can apply those skills to say whatever they want, Schlaug says. He says they learn to first "hear" what they want to say in their head, and then they plan the appropriate intonation. This means they have to think -- a lot -- before speaking, so their speech isn't as quick or spontaneous as it was before the brain damage.
“One of the reasons it works is that both sides of the brain can vocalize,” says Schlaug. “So if you have a large left side lesion, which Gabrielle Giffords seems to have, there is still a chance that you can basically train the right side of the brain to do some of the basic communication tasks.”
Schlaug explains that melodic intonation therapy essentially tricks the right side of the brain into taking over for the left when it comes to language and communication. Because the right side of the brain, as Schlaug phrases it, is more “interested” in melodies and intonation.
It's a small trial, including just 12 patients, but musical intonation therapy has helped a couple of patients so far, Schlaug says, giving them back their voice.