Toronto project demonstrates healing power of arts
By Joseph HallNews reporter
Sun., April 3, 2016timer9 min. read
It's the most graceful pirouette Rachel Bar ever performed.
When her prima ballerina dreams began to fade eight years ago, she spun her talents onto a more elevated stage.
"I just felt like there was more to me … more to say," she recalls. "And I didn't think I was going to be able to say that through my performing."
Bar now offers dance therapy to people with Parkinson's disease in the GTA.
Bar, 31, who danced for six years with major British and Israeli companies, is coupling her dance therapy instruction with a scientific study of Parkinson's. In doing so, she has become a key partner in a three-year effort to carve out a permanent place for the arts in the province's health system.
Led by the University Health Network's OpenLab centre, the Art Heals Health project is bringing together disparate artists who work in medical settings and display the clinical value they add to patient care, at relatively low costs.
Ultimately the project hopes to help long-term provincial funding for the arts as therapeutic tools, says Kendra Delicaet, managing director of OpenLab, which studies and bolsters creative programs to improve the delivery and patient experience of health care.
The project, one of about a dozen the centre is running, is recruiting dancers, painters, musicians, actors and comics who are currently taking their talents into hospital and outpatient settings.
About 170 artists, therapists and clinicians from across the province and beyond attended an initial project symposium last fall. The program co-ordinated by OpenLab hasn't yet costed out the three-year project.
The notion that art can improve medical outcomes is not new. But an increasing number of large studies support the idea, says Dr. Luis Fornazzari, a neurologist at St. Michael's Hospital and a medical adviser to the OpenLab project.
"There are many articles that are pointing to the very good effects of art," he says. "Heart attacks, ICU patients, patients admitted (for) bypass coronary artery diseases and other big surgeries … they respond much, much better."
These responses, Fornazzari says, include lower use of painkillers and shortened hospital stays, cutting costs and helping the arguments for artistic interventions.
Just why art can lead to truncated, less painful recoveries and other physiological benefits is unclear, he says. But it's likely due in part to positive effects of the neurochemicals, such as opioids and dopamine, released during participation in artistic activities.
Fornazzari's own work has looked primarily at the protective effects that art offers the brain against the onset of dementias. Artists in particular are significantly "protected by their art," sometimes for years, against the cognitive deteriorations caused by Alzheimer's disease, strokes and other brain disorders, his research has shown.
Bar is completing a doctorate in clinical psychology at Ryerson University. And she has enlisted some of her dance class participants in a research project exploring the effects of dance on a Parkinson's brain.
"We know that balance and gait and posture … do improve, and overall that dance can actually delay the progression of the disease," she said after a recent class at Canada's National Ballet School.
"Our research looks at … what's unique about dance in the brain that facilitates these benefits," added Bar, a graduate of the Jarvis St. school. (She also teaches adult and children's programs at the facility.)
Bar and her research colleague — York University neuroscientist Joseph DeSouza — use electroencephalograms (EEGs) to search for differences in dancers' brain waves before and after classes.
They've also used functional MRI scans to look at neurological changes that occur in real time during the dance.
Some 36 weeks pregnant with her second child, Bar left much of the actual instruction during the recent class to a pair of ballet school dancers, who led 18 Parkinson's patients through a series of sitting and standing moves in one of the facility's elegant pastel studios.
The ballet school program, with 30 registrants with Parkinson's each term, partners with the group Dancing With Parkinson's, which runs classes in five other locations across the city.
Bill Bartlett dances three times a week at several of them.
The gregarious, barrel-chested 71-year-old quit his career as a chef when he developed significant symptoms of the degenerative movement disorder four years ago. Like many who use art as therapy, Bartlett says ballet has drawn him out of the isolation in which illness can frequently imprison a mind.
"Many people with Parkinson's withdraw (but this) energizes me every day," he says. "It gives me something to look forward to, to defer depression."
Bar, whose favourite ballets to perform were Sleeping Beauty and Swan Lake, says the use of dance in her academic work flowed naturally from her former career.
"You kind of go back to who you are and what you know."
Bar and Fornazzari believe benefits they've documented — physiological, emotional, spiritual and economic — have earned the ancient arts a firm place in modern medicine.
But she notes the medical community relies on hard data to justify change. She and the other artists working in the program hope to supply just that.
Humour out of darkness
Toronto author, actor and comedian Robert Hawke is marshalling humour in the battle against cancer, after it helped him through his own bout with the disease.
His comedy career was riding a high-speed laugh track a decade ago, having brought him frequent appearances on CBC television and radio shows and a full-time gig with the Second City comedy troupe. "I was freelancing, things were good," he recalls. "And I was leading what I considered to be a pretty healthy life." But then cancer sent him off the rails.
Hawke learned he had a thyroid tumour and that the master metabolism gland would have to be removed. The diagnosis and treatment proved psychological blows as much as physical ones. During weeks of fretful recovery, however, he hit upon this "funny idea" — to combat his cancer with comedy. The material he started developing and writing then would build a new calling and career.
"Once I started doing (comedy) work that addressed the cancer experience, I realized there was a real need for it," says Hawke, now 50. That need found its source in the deep wells of fear, despair and isolation into which cancer patients often fall. Using his comic skills to make cancer patients laugh, he thought, could help haul them out of that "4 a.m." darkness and allow them to more readily share their experiences and insights about their battles with others in similar straits.
Hawke has developed several programs to address different audiences. For cancer patients themselves, his "Spoonful of Laughter" routine is a 40-minute exercise that leans heavily on teaching improv techniques in groups large and small. Another, called "NormVsCancer," is an irreverent one-man show that OpenLab helped him bring into hospitals and other medical settings. He also created a program — Adventures in Patient-Centred Care — that teaches second-year University of Toronto medical students how to interact with more humour and humanity in the clinic.
Hawke believes that shared laughter is a key to opening cancer patients up to the camaraderie, comfort and expert advice — the "wisdom in the room" — that can be found in fellow patients. And the reactions of patients involved in one of his recent improv exercises seemed to bear him out.
"I don't think we get enough opportunities to laugh," said participant Nadha Hassen, 26, who is battling thyroid cancer. "It's amazing to … be in a space with other (patients). I feel like I just took this amazing stretch."
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Hawke also published a how-to book in 2011, called Kicking Cancer's Ass: A Light-Hearted Guide to the Fight of Your Life. It offers cancer patients strategies on dealing with doctors, setting up support groups, making healthier choices and overcoming the bouts of worry and depression the disease can bring.
Writing songs with the dying
At Toronto's Princess Margaret Cancer Centre, SarahRose Black adds a keyboard's lively chords to the chemotherapy's weary drip.
"I bring my keyboard, I bring my (Tibetan) singing bowls, I bring a variety of instruments and my voice," says Black, an accredited music therapist who has become an integral member of the hospital's medical team.
Like psychologists or chaplains, Black, 28, sees patients based on referrals from physicians and other health professionals.
"I see people who have been first diagnosed with cancer and who are going through active treatment all the way through to end-of-life and palliative care," she says.
"If patients are experiencing symptoms that are very distressing or have high anxiety or perhaps are experiencing existential distress, I can be referred."
Princess Margaret is part of the University Health Network, which houses the OpenLab program.
Black says anecdotal and academic evidence has convinced her of music's healing power, a key reason she entered her chosen field. She often works in interactive sessions with patients — pulling them into a musical participation that she and many believe has measurable therapeutic benefits.
"Sometimes patients are interested in picking up a guitar that maybe they haven't picked up in years, or singing a meaningful song with me," she says.
"Or if they're well enough, (they can) hold one of my instruments, like a percussion instrument, and we improvise together."
For those patients too tired or sick to participate, Black will take bedside requests, playing tunes that resonate with the patient.
"But often they say, 'Whatever. Just play whatever,'" she says.
"So I end up doing something … improvisational."
Black also works with the dying — patients transferred to Princess Margaret's 10-bed Kensington Hospice who might wish to leave a musical legacy of their lives.
"Many, many times I've been in with people who know they're dying … and in the course of one or two (visits) we write a song together," she says.
"I put it on a CD and the patient can give it to their loved ones as a gift."
These songs are often played at funerals, says Black.
In all these circumstances, Black says, her live sessions have an interactive advantage over recorded music — allowing her to tune a performance to a patient's mood, strength and desires.
"If I can connect with someone and meet them where they're at and cater the music to their unique experience, the therapeutic potential is enormous."
Black's Princess Margaret gig began three years ago as a student internship. She now holds a permanent position at the hospital, which she's using to help her complete a U of T doctorate in music and health.
"People tell me that the experience of listening to music in their hospital room humanizes their care," she says. "Suddenly they're not just a patient but they are a human being with complex needs."
Black says research shows this humanizing effect of music produces consistent clinical benefits, helping with pain and symptom management of drugs, radiation and surgery.
In a cancer hospital, however, music may frequently be the final therapy.
"I often get called in when there are no words left. It's just music, and silence."
Measuring art's healing power
The Lancet, August 2015
This retrospective study of some 4,200 previous research papers showed music played in post-operative settings provided patients with significant reductions in pain, anxiety and use of analgesics, and increased satisfaction with their hospital stays.
Canadian Journal of Neurological Sciences, August 2013
This study was based on internationally acclaimed sculptor Mary Hecht, who taught at York University. Though she had profound dementia in her last years, Hecht could still draw accurate images of people and objects around her. This suggested that art could bestow protection for the brain.
Pediatrics, May 2013
Researchers looked at 272 premature babies who had lullabies and heartbeat and womb sounds sung or played to them by parents and registered music therapists, while in neonatal intensive care units. It found that the songs and sounds could slow the baby's heart rates, make them more alert and improve their sucking.