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Neurologic music therapy is a new digital therapeutic to improve activities, like walking
Bambi Francisco Roizen interviews MedRhythms Co-founder and CEO Brian Harris. MedRhythms is a digital therapeutics company that uses sensors, music, and AI to build evidence-based, neurologic interventions to measure and improve walking.
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Some takeaways (edited for clarity)
--- I've always been fascinated with the potential of music to help people. I worked with a music therapist who was working with an 18-yr-old patient who was cognitively behaving at a one-year-old level. Within 10 minutes of live music, the boy began functioning cognitively. At that moment, I realized the intersection of music and cognitive function was my calling.
--- Music therapy became established and backed up by evidence around the 1950s. Around 1999, that’s when neurologic music therapy began to emerge due to advances in neuroscience and neuro-imaging. We were able to explain objectively and make standardized interventions based on that objective neuroscientific research.
--- Neurologic music therapy is objective neuroscience research understanding how music engages the brain and improves walking, talking and cognition
--- Clearly the market for music therapists, let alone neurologic music therapists is nascent. There’s 8k music therapists in the US. There are 3k neurologic music therapists. This compares to the largest physical therapy company in the US with 10k employees (own 3% of the physical therapy market).
--- MedRhytms makes digital therapeutics to improve walking after neurological injuries. Music and rhythm can engage the motor systems in the brain that's responsible for movement to improve walking. Our initial indication is stroke and the 3.5 million people who are post-stroke with walking deficits. Eventually, we'll move into MS, Parkinson's.
--- Everyone’s brain objectively responds the same way to music. When passively listening to music, our brain is activated. The parts of the brain responsible for movement, language, attention, memory, emotion are activated. There's no other stimulus on earth that engages simultaneously like music does.
--- Even when learning an instrument, or casually singing, these actions aid in neuroplasticity, the brain's ability to create new connections or strengthen old connections. People can learn new things as we age. So if people have traumatic brain damage, they can recover. It’s been shown engaging in music activates neuroplasticity. What's happening here is that when the brain hears an external rhythm, the auditory system is activated. And because our auditory and motor system are connected via the reticulospinal tract, an auditory cue can engage both the auditory and motor system. This is applicable to healthy individuals and those who have damaged neurologic conditions.
-- The auditory and motor entrainment is applied through a standardized intervention called Rhythmic auditory stimulation, which has been studied for about three decades in the lab setting, demonstrating it can improve stride length, balance, and reduce falls. We’ve digitized rhythmic auditory stimulation in the home without a clinician.
--- Can this auditory cue be used to help those with peripheral neuropathy? Even if a person doesn't have a brain deficit (e.g. someone with peripheral neuropathy), music can still be a benefit. Early research has been done to show that music can have an impact on creating more efficient movement patterns that result in less wear and tear of the knees and might even help create endurance (more repetitions). There's a lot of clinical hypothesis but not much research.
--- The intervention consists of 30 minute sessions three times a week for several months. The patient typically has chronic stroke and has undergone physical therapy three to six months. About half of people who have stroke, are left with chronic walking deficit. It’s at that chronic phase that it’s been historically believed that’s when they’ve plateaued physically. But we've shown that neuroplasticity can improve motor function in the future. We can continue to stimulate areas of the brain that triggers motor function so a person can make more progress. This also can help counter deterioration of muscle mass.
--- Last year, mid-2020, we were granted breakthrough recognition by the FDA. We're currently in the midst of a pivotal trial. Once the trial is completed, the report will be submitted to the FDA. We expect each product will take about three years at best to get through the FDA approval process and to market. [The avg time a drug gets through the FDA is nine years]
--- Improvement is measured by walking speed, length of stride, evenness of stride.
--- In the market? Pre-commercial. We’re in the midst of pivotal trial for our first product. From this trial, we’ll submit to FDA. Digital therapeutic - prescription, evidence-based through rigorous trials and FDA approved. We think like a pharma company. We hope an FDA approval in not so distance future.
--- Side effects? You can’t overdose on music. Unless you hate the music, there is no negative side effects.
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