UT professor studies how playing ukulele could improve cognition for people with multiple sclerosis

This transcript was transcribed by AI and lightly edited by a human.

Jennifer Stayton: Multiple sclerosis is a chronic disorder that can cause muscle weakness; numbness and pain in the extremities; and balance and vision problems. It can also cause fatigue; mood changes; and cognitive and memory problems.

There is no specific test for MS. And there is no cure. Much of the treatment focuses on addressing symptoms and trying to reduce relapses and slow the disease’s progression.

Dr. Carolyn Phillips, an assistant professor in UT's School of Nursing, is working on adding another tool to that treatment kit — music.

We talked just before the holidays about that work — and why she thinks music can make a difference:

Carolyn Phillips: It engages every part of the brain at one time. So it connects to your cognitive domain, your emotions, your motor skills, but also your sensory system — so auditory, visual, tactile. And by being able to engage all of these aspects of your brain, you can use it in all of those different ways to tap into processing emotions, to help regulate gait or your walk. By listening to music, you can help tap into you know, movement better, so it can be used in almost every aspect of life.

Jennifer Stayton: To help improve health. When you talk about music-based intervention in a therapeutic setting, what exactly is that intervention?

Carolyn Phillips: So they refer to it as passive engagement — that's music listening — versus active engagement, which is singing, playing a musical instrument, dancing.

Jennifer Stayton: Tell us specifically what you're working on right now.

Carolyn Phillips: Yeah, so right now I'm focused on a cognitive rehabilitation program called Music4MS. It's a 12-week virtual intervention that teaches people with multiple sclerosis how to play the ukulele.

Jennifer Stayton: Why the ukulele?

Carolyn Phillips: First and foremost, I play the ukulele so I can understand its accessibility to others. It's an easy instrument to play. It has four strings. You don't need as much dexterity to be able to play it. Holding the chords is more simple and it's affordable. You can get a good ukuleles for a couple hundred dollars or less.

I've been able to work with people with all levels of physical abilities with the ukulele. So we've had people in our studies who used to play the guitar, but once they were diagnosed with multiple sclerosis, they couldn't hold the guitars too big for them. Another person in our study is in a wheelchair and doesn't have use fully of her right arm, but she didn't need that fine motor skill to be able to do it. And then she was able to work with her caregiver who would help hold the cords on one hand, and then she would be able to strum on the other hand.

Jennifer Stayton: Can people who never played a musical instrument in their lives up until this point be able to engage with this kind of intervention, even if they don't have a musical background?

Carolyn Phillips: This is the simple answer. I think that we have almost this dichotomous way of thinking about music, and especially playing a musical instrument: I'm musical or I'm not, I can or I can't. Music is a very powerful multisensory tool that can be used to improve brain health. But if you have that I'm-musical-or-I'm-not thinking, that limits the way that music can be used in health care.

And so, yes, I do believe that anybody can play the ukulele or learn how to play a musical instrument if you don't have the mark of success being I'm good or I'm not.

Jennifer Stayton: So with music for MS, what is the goal of that series and the music-based intervention?

Carolyn Phillips: Our hope is that it will improve cognition, and so that is our primary outcome that we're looking at. And we've done a very preliminary proof of concept study. We did a randomized controlled trial, and people who were in the ukulele group, compared to people who are just listening to music, over that 12-week period, people in the ukulele group had significant improvements in anxiety, depression, and in cognitive flexibility.

And then one month later, people in the ukulele group outperformed people in music listening group on all of the cognitive tests that we conducted.

Now it was a small proof of concept study and so we were primarily looking at feasibility and acceptability. But we did show very good signals that this can improve cognition.

Jennifer Stayton: What exactly is the next step then in the process if you're looking for causation and maybe not just correlation that the music-based intervention is what's impacting the cognitive improvement?

Carolyn Phillips: The next step for us is to be able to have a large, well-powered efficacy trial. So I've written a large grant to be be able conduct the next step, which is a stronger efficacy trial, but it is just sitting there waiting for the NIH just to start functioning again.

Jennifer Stayton: For folks who are listening to this discussion and thinking, music and medicine and science, that's all just a little like woo-woo for me. I don't know if I buy this. Music is gonna help with cognitive improvement for folks with multiple sclerosis. Help us get over that hurdle or barrier to understanding this.

Carolyn Phillips: Music in art is expressive, but the science behind it is rigorous. And so music is a tool like any other tool we have, and it's actually a more accessible tool and it is a universal tool that people relate to. The science has shown us that music impacts every part of the brain. The science is there telling us that music will help improve cognition. Now it is just proving it in large studies and really being able to show the long-term effects of this.

Jennifer Stayton: Is there something specific that brought you to study music-based intervention with multiple sclerosis?

Carolyn Phillips: I think that there were three formative points for me. First, my science started with looking at music-based interventions. And I've been doing that for the past about 10 years. Then during my doctoral training. I had the opportunity to work with my mentor, Dr. Alexis Steiffbergen, who studies cognitive rehabilitation for people who have multiple sclerosis.

And then third, I have to say that this work isn't abstract for me. After I was diagnosed with MS, I experienced firsthand the invisible symptoms like fatigue, cognitive challenges, and emotional uncertainty that are often overlooked and understudied. So my personal experience with MS doesn't replace the science, but it does sharpen my questions.

Jennifer Stayton: May I ask if you play the ukulele as part of your just maintaining and looking out for your own health?

Carolyn Phillips: I do. Yeah, I do, and I feel like it's able to give me insight in terms of how to balance the cognitive challenges in music learning because there is this moment of being cognitively overloaded, where it's challenging to process new information coming in. It's challenging to remember the music. And so in those moments, like they're directly affected by my energy levels of the day.

And so I'm able to think about those challenges from firsthand experience to help me design the music interventions for people who have cognitive challenges to try to find that sweet spot — that liminal learning zone is what I like to call it — the sweet spot between being not too challenging but challenging enough to help keep inducing that neuroplasticity, helping keeping them engaged, but gaining that positive reward for playing an instrument.

Jennifer Stayton: Dr. Carolyn Phillips is an assistant professor in UT Austin School of Nursing. And Carolyn, thank you for your conversation today, sharing your work and your personal journey with us.

Carolyn Phillips: Thank you so much for this opportunity.