Young caucasian woman listening music at home.
Today marks the fourteenth annual World MS Day – a day to reflect on the experiences, challenges and aspirations of the 2.5 million people around the world living with multiple sclerosis.
A neurological condition principally diagnosed in adults between the ages of 20 and 40 – some of the disease’s defining features and hardest to treat manifestations involve problems with gait, walking and mobility.
Approximately 80% of all people with MS go on to develop problems with walking within 10-15 years of diagnosis and these issues can encompass poor balance and coordination, weak and stiff muscles and partial paralysis of the muscles used to raise the foot when stepping forwards – a symptom known as drop foot.
To date, there has been a dearth of options to improve or maintain walking in MS aside from adherence to physical therapy or the use of mobility supports such as canes, crutches and orthotics.
Therapeutic strides
However, a new and innovative treatment modality that patients with MS will be able to practice from the safety of their own home in the shape of music therapy may be just around the corner.
Music therapy in its simplest form has been around since the 1950s and has proved particularly beneficial in helping those with communication difficulties and psychiatric disorders, as well as in child development.
However, Portland-based digital therapeutics startup MedRhythms is attempting to take things to the next level by adopting a software and hardware-based approach to tap in more directly to the underlying neuroscience behind music therapy – assisting the brain in directly building new connections through a process known as neuroplasticity.
For anyone who thinks the treatment sounds in any sense woolly, ultra-experimental, or something that only has a place at the extreme periphery of medical science – think again.
Pharmaceutical giant Biogen has placed its considerable heft behind MedRhythm’s research into a music-based digital therapeutic to help people with MS by pledging an initial $3 million towards further development and commercialization of the company’s MS product line known as MR-004.
This could rise to $117.5 million should certain development and commercial milestones be met in addition to royalties on eventual sales.
Addressing Biogen’s collaboration with the company, which is also undertaking active research into the application of music therapy for stroke, Parkinson’s and Alzheimer’s, Martin Dubuc, Head of Biogen Digital Health said, “As part of our aspiration in digital health, together with MedRhythms, we aim to advance a new, innovative treatment option for people living with MS that may help address walking impairment, a common issue that impacts their overall quality of life.”
Explaining the fundamentals behind MedRhythm’s MS-related research, Brian Harris the company’s CEO and co-founder, and one of only 350 specialists and practitioners in Neurologic Music Therapy worldwide, says, “Regardless of age, culture, ability or disability, everybody's brain objectively responds to music."
He continues, “The two primary principles are what we call global activation, and neuroplasticity. So, what the research shows is that when we as humans passively listen to music that we like, it engages or activates the parts of our brain that are responsible for movement, language, attention, memory, emotion and executive function. Quite simply, there's no other stimulus on earth that engages our brain like music does.”
Step to the beat
The auditory and motor components of the human brain are intrinsically connected at a deep subconscious level. Music, or more precisely, it’s rhythmic output, serves as a natural trigger of movement. Hence, the urge to dance or tap one’s foot when one hears a catchy tune.
MedRhythym’s technology, which uses sensors in the patient’s shoes to gather data on walking parameters such as stride length and cadence as well as specialist algorithms to match this to musical output using a mobile device and headphones, reinforces the innate coupling of the auditory and motor systems through external rhythmic cues.
Over a period of time, rhythmic auditory stimulation (RAS) via a process known as entrainment can lead to improvements in gait and mobility by encouraging the brain to forge and fire new neural pathways and connections – taking advantage of the brain’s elemental plasticity or capacity to rewire itself.
After taking baseline measurements, the music is then adapted and personalized for the patient’s neurological circuitry to elicit pre-determined functional gains such as increased speed or step quality and symmetry.
MedRhythms therapeutic cycle
In terms of what the patient hears, the music needs to be precisely matched to the tempo of their walking and this is done through a process of algorithmic screening and mixing.
It should be noted that the patient is listening to ordinary, everyday music hits as one might hear on the radio but with important characteristics subtley tweaked – for example rhythm and beat salience to mirror the patient’s walking patterns and goals.
As Harris enthusiastically explains, “So, the way we have to mix the songs – it’s almost like a kind of healthcare DJ. It’s just like what DJs do but rather than it being for people on the dance floor, we’re changing those inputs to match a clinical need.”
To facilitate access to rich and diverse content, the company has collaborated with Universal Music, which owns 40% of the world’s music and hopes to be able to leverage that catalog moving forwards.
Currently, MedRhythms, which was founded in 2015, is furthest down the line in terms of FDA approval and licensing for its stroke protocol but is in the process of evaluating its MS offering via two feasibility studies.
The first is being conducted at the Cleveland Clinic and the second at the Massachusetts General Hospital.
Genuine hope exists that one day soon, MR-004 could become the first-ever prescription digital therapeutic to address walking issues in MS.
This would be a welcome addition to a crucial area of unmet clinical need. Even if the algorithmic DJ in the cloud is the one selecting and mixing the tunes – this might just end up being a most useful tool to help people with MS to maintain independence, rely less on others and march that bit more to the beat of their own drum.
