Skip to main content

Singing while you walk and learning to communicate between the towers of academia

Émile Jaques-Dalcroze

As a geriatrician and an ethnomusicologist, I have had ample opportunity to observe the impact of music upon gait among my patients. Whether singing “Tumbalalaika” in order to help a Parkinsonian patient avoid freezing on a threshold, or singing “Won’t You Come Home, Bill Bailey,” in order to help someone with dementia get up and walk to the dining hall, I have watched as halting, shuffling gaits develop a steady rhythm. In each case, the patient begins to walk in synchrony with the song and the caregiver.

It was with delight, therefore, that I read the article by Trombetti, et al., in the upcoming issue of the Archives of Internal Medicine. They have taken such anecdotal experiences and subjected them to the rigors of the randomized clinical trial. Powered to detect measurable differences in gait, they have demonstrated in medical parlance what many of us have seen, that gait can improve with music.

Trombetti and colleagues offer us an interesting piece of information: that community-dwelling elders can have improved ability to ambulate when their steps are accompanied by piano music. They used Jacques-Dalcroze Eurythmics (an established music pedagogical approach that was developed in the late 19th century) in a 12 month-long RCT involving 134 community dwelling elders and an accepted research methodology. For the first time it has been shown, they say, “that participation in music-based multitask exercise classes once a week over a 6-month period can improve gait performance…and reduce both the rate of falls and the risk of falling in at-risk elderly community-dwelling adults” (online advance publication, November 22, 2010, p. E7).

It’s a great article, accepted in a highly reputable medical journal. My only question: where’s the music?

For the most part the authors appropriately cite the handful of music therapy articles that deal with gait. It's a shame, though, that they miss Alicia Ann Clair’s interesting work on rhythmic-auditory-stimulation (RAS). In one of the rare “negative finding” publications, she demonstrated that RAS did not lead to a significant difference in gait, but discovered that the caregivers involved in the study reported that ambulating a patient seemed easier when the music was playing.

The inclusion of music therapy literature in a medical journal is important here. There is more, however, to music research than music therapy and music’s therapeutic value. In the fields of ethnomusicology, music education (the academic home of Dalcroze Eurythmics), pscyhomusicology, psychology, neurology, gerontologic nursing, and geriatrics, some of us examine the music itself as well as its habilitative and rehabilitative effects. There is even a new analogue to medical anthropology, called medical ethnomusicology, which is devoted to issues of music, culture, health and healing.

As a musicologist, I would like to hear more about the music chosen in these sessions. Was it all improvised? And if so, how was the give-and-take established between the instructor and students? Were there direct musical references to melodies from childhood? Were there performances of familiar songs? Did the choice of music make a difference in its efficacy? It is unreasonable to ask a group of physicians and researchers to take an article this far in the Archives. But it is absolutely reasonable to begin a conversation.

Now is the time for each of us to step outside of our academic silos, following in the footsteps of Trombetti and colleagues. They have built a bridge between geriatric falls prevention and music education in order to keep older people from falling. Our older patients will benefit from this stretch between the disciplines.

Reaching out across disciplines brings a multi-faceted understanding of the problems, and a better understanding of potential solutions. Will I be able to start a Dalcroze school at the nursing home where I practice? No. But I will feel more confident as I continue to encourage my patients to sing as they walk. And I would be delighted to start building more bridges across the academy.


Trombetti, A; Hars, M.; Herrmann, FR; Kressig, RW; Ferrari, S; Rizzoli, R. Effect of Music-Based Multitask Training on Gait, Balance and Fall Risk in Elderly People. Archives of Internal Medicine. Published online November 22, 2010.

by: Theresa Allison


Anonymous said…
Coincidentally, here are two recent related publications - a book review of "The Music Instinct: How Music Works and Why We Can’t Do Without It" by Philip Ball at BMJ 2010; 341:c6965 doi: 10.1136/bmj.c6965 (Published 8 December 2010) & an essay entitled "Music for healing: from magic to medicine" in The Lancet, Volume 376, Issue 9757, Pages 1980 - 1981, 11 December 2010.

Our palliative care service in Canada hired a music therapist several years ago who has proved to be a very valuable and skilful team member.

Its interesting to see research on music entering the mainstream.

Paul McIntyre

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block

Nursing homes are a tough place to do palliative care.  There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice.  So what can we do to improve the palliative care outlook in nursing homes?

On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week.  Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…