S2 Episode 1: How Gabby Giffords Found Her Voice

Maegan Morrow, music therapist at TIRR Herman
Photo courtesy Maegan Morrow and TIRR Memorial Hermann Hospital

After the shocking 2011 attack that sent a would-be assassin’s bullet through her brain, former Rep. Gabrielle Giffords had to re-learn how to breathe, walk, and talk. In the Season 2 premiere episode of This Is Your Brain, Dr. Stieg talks with neurologic music therapist Maegan Morrow, whose innovative techniques helped Giffords regain her voice.  Plus: A bonus interview with Ms. Giffords herself

Phil Stieg: With me today is Maegan Morrow. She is a board-certified music therapist and a member of the American Music Therapy Association and currently works at TIRR Memorial Hermann Hospital. Maegan is well known for her work with Congresswoman Gabby Giffords. She has been featured in national and international media, including Dr. Sanjay Gupta’s medical interviews on CNN, Newsweek, USA Today, the Grammys.com and ABC Nightline with Bob Woodruff. In 2012, she and her team at TIRR Memorial Hermann were chosen as Diane Sawyer’s Persons of the Week.

Maegan, thank you so much for being with me today.

Maegan Morrow: Thank you for having me.

Phil Stieg: So we want to start focusing a little bit on Gabrielle Giffords. We should note that it was exactly 10 years ago this week she was the victim of a brutal assassination attempt…

911 Operator: 911, where is the emergency?
911 caller: Oh 911 – There is a shooting at Oracle where Gabrielle Giffords was. And I do believe that Gabby Giffords has been hit.
Local TV anchor: We have breaking news for you is coming out of Tucson, Arizona. Several people have been shot. Among those shooting victims is Congresswoman Gabrielle Giffords….
President Obama I know Gabby is as tough as they come. I am hopeful that she’s going to pull through.

Phil Stieg: Gabby’s condition was stabilized at the University Medical Center in Tucson, and about two weeks later she was transferred to TIRR Memorial Herman, your hospital in Houston, so that she could be near her husband, astronaut Mark Kelly. Maegan, I would really appreciate it if you could describe Gabby’s condition when she first came to your hospital.

Maegan Morrow: When Gabby first came to TIRR, she was unable to speak. She was unable to attend, and she was unable to move her right side. The left side of the brain controls the right side of the body. And after she had been shot, her right side was affected. So she was unable to speak and unable to walk and unable to move her right arm.

Phil Stieg: How do you communicate with the person that early on to try to get their attention? What trick did you use?

Maegan Morrow: (laugh) I like that. What trick? Well, before she even met me, one of her friends was a musician and he had come in to visit her. He borrowed my keyboard and he started playing musical theater tunes with her. So he was doing something that I usually do when I meet someone, which is just starting to prime the pathways in the brain by playing some familiar music, and I usually like to use something live so that I can control the tempo and the timbre and all that sort of thing.

Phil Stieg: And she responded to that music as you played it?

Maegan Morrow: She did. She was alert. She was attentive. She was moving her head. And that was similar to what happened when I met her in the next few days. So I knew that she was going to be working with some attention problems, communication problems. So I always start with something really simple or repetitive.  Like you said, the trick that I usually use is that I’ll bring in an instrument and I’ll accompany myself and sing something that’s very familiar.

Phil Stieg: This is amazing because just this week I was taking a tumor out of somebody’s brain that had located right in Broca’s area, the speech cortex. And the neuropsychologist during the procedure was having the patient sing Amazing Grace and the national anthem. And the patient preoperatively had a very hard time talking, but she sang the songs impeccably.

Maegan Morrow: Wow. They knew to do that. That’s what’s amazing to me.

Phil Stieg: So how did you go, I mean, you knew that this friend had played music. Is that how you started beginning to create connections with Gabby? Is that your first technique?

Maegan Morrow: Well, the family is a big part of the assessment process. When someone has aphasia where they can’t communicate what they want to say and they’re in such a state of mind where they can’t communicate, there’s there might not be attention there. I usually interview the family and I start to find out, OK, what is their musical background? What did they listen to on a daily basis? What did they grow up listening to?  So I was able to gather that information. And she actually you know, there are cues in the room. There was a boombox and some CDs. And one of her favorite bands was there, Calexico. They were an indie rock band from like L.A. or Arizona. And then there was, of course, U2. Bono was one of her favorite singers. So I knew what genre I could use with her. And also just Western music, what we use here in America.  I’m going to use things that she might have learned in school or, you know.  She was in band in high school, and I knew that she had played instruments before. So I’m kind of gathering from those that little pile of information. And then I would choose a song to sing with her to see if I would gain any attention from that or get any speak utterances.

Phil Stieg: So basically, you look for something familiar in any music genre that you’re going to be able to relate to with the patient   When was the first big “aha”?

Maegan Morrow: The first big “aha” was the very first time that I met her. I started singing some familiar songs by her bedside. I looked at her and I could see that she was attending to me and giving me that eye contact as I sang. And I knew that I could go a little step further and try to get her to sing. I gave her the directive to sing along to the most simple song, Happy Birthday to You. 

And when I sang Happy Birthday to — and I just left that phrase open for her to fill in, she was able to nod her head and give me a little thumbs up. So I saw in her gestures that she was trying to fill in the words to the song.  When it was her turn to sing, she would do a gesture for me. And when I saw that, I knew, OK, we’re onto something. We are going to get her speech back.

Phil Stieg: We’ll return to our conversation with Maegan Morrow after a break.

I’d like to introduce an occasional segment which is new to our podcast this season. We’re calling it – This Is Your Brain: The Guided Tour.

BREAK: This Is Your Brain: The Guided Tour: Ear worms

Phil Stieg: So let’s focus a little bit on what music therapy is and to start off with what’s actually going on in the brain that makes music such a powerful therapeutic tool.

Maegan Morrow: Music is really dispersed all over the brain in different areas. And I always go back to rhythm. We know that even if we’re just using rhythm in the environment, we can actually see changes in the brain. 

In the initial stages when I was working with Gabby and many of my patients, I will use instrument play to even get them to communicate through drumming or playing some type of non-threatening instrument that is easy for them as a non-musician. And some of those things can actually help with movement, attention, even speech. So if someone can’t communicate verbally or vocally, I can allow them to communicate on their instrument.

Phil Stieg: Do you think the speech gets better because, one, they’re forming new neuronal circuits or is there another component to it where their innate stem cells are activated and they form new neurons? 

Maegan Morrow: I think that, like within the technique of melodic intonation therapy, a lot of it is just the neuroplasticity of the brain. When when the brain receives the melody and the rhythm, it’s able to produce sound or singing vocalization. And at times like if you have a problem like aphasia or apraxia, they may be able to receive that information, but they can’t get it out. And so there’s an area in the brain that is a bundle of nerve fibers called the arcuate fasciculus that can connect the Wernicke’s area to the Broca’s area.

Phil Stieg: And so the listeners understand Wernicke’s uses the receptive area and Broca’s is the motor component of speech.

Maegan Morrow: Right. And so those two areas can be connected by building new pathways. And music is one of the best ways to build those pathways, because elements of music are all over the brain. And they used to say, you know, music is on the right side of the brain and language is on the left side. But now they’ve found that music is really dispersed throughout. But even within that melodic therapy technique that I use, I am retrieving lyrics from the right side and trying to build a pathway from right to left.   

Phil Stieg: So given the timeframe, you know, two weeks after injury, one has to assume that this is just new circuits, not new cells developing because that would take a lot longer for recovery and maybe that does play a role in later recovery.

Maegan Morrow: Yes! And that is that is still to be seen and researched. I mean, we’re talking to each other like we know what’s going on, but we know the tip of the iceberg right now. You know, just in the last 20 or 30 years, we have MRI so we can see where the blood flow is happening in the brain. But there’s so much more going on, obviously, and we’ll find that out over these years of doing research.

Phil Stieg: It never ceases to amaze me that there’s a another syndrome in the right parietal lobe, where if you talk to the patient—I’m sure you’re familiar with this—you talk to them and they won’t respond but if you put at telephone in their hand they’ll talk back to you.

Maegan Morrow: Yes, we do that trick all the time. That concept we use here, and I’ll bring in my microphone and I’ll do the same thing just to get them to initiate if I put the microphone in front of them.

Phil Stieg: What advice do you give to the family members? They’re sitting there looking at their loved one who can’t mumble a word and their face gets long. The patient can read that. So what do you tell them? How to behave around their loved one and at times like this?

Maegan Morrow: When patients are in a really low state of consciousness, we always try to explain to them that their auditory system is very powerful and they can still hear you. Whether we can tell if they understand us or not doesn’t mean that those regions aren’t working. So to still talk to them like they are your friend or your family, use their name, you know, treat them like as if they’re in the room.

Phil Stieg: Be normal—

Maegan Morrow: Yeah, normal, so to speak.  And further to give the family something to do using music, I always encourage them to have music by the bedside, you know, at good volumes that would be safe for them, for listening, not to overwhelm them with too much music that can be fatiguing, but it can definitely mask the environmental sounds of the hospital, which automatically create anxiety. Shut the doors, use music to mask that environmental sound and to bring that familiarity again, something that will comfort them and decrease anxiety in the hospital.

Phil Stieg: Is this common therapy that people are getting when they get transferred to a rehab hospital? Does every place have this or should the other people listening to this start asking for it when their loved ones have difficulty with speaking?

Maegan Morrow: Our program has music therapy as part of the standard of care.  And it is very normal here for me to see anyone and everyone in the hospital.  I think that just the more people see how it can be used with every diagnosis, it may, you know, alert them to give someone a chance.

Phil Stieg: Let me ask about different disorders, do we find that music therapy is beneficial in other neurologic disorders like anxiety, depression, loneliness, separation? I would think so. But is there a defined therapeutic intervention with music for those issues?

Maegan Morrow: Yes. This field started at the psycho-social domain. And so a lot of therapists are working in psychiatric hospitals and with mental illness. And using music is a very easy way to connect with somebody, even just having someone open up about their mental health, their depression or anxiety through listening to music and analyzing lyrics, maybe even writing your own lyrics and empowering people through writing music or even just participating in music activity.

Phil Stieg: In your notes, I was reading a little bit about your concentration on the topics of repetition and consistency. It made me think and I always like to disavow people thinking of the brain as a muscle, you know.

Maegan Morrow: Yeah.

Phil Stieg: I got to hit five thousand golf balls to hit one well, you know. But in that regard, I completely agree. I mean, the brain is trainable and repetition does help. Can you comment on that?

Maegan Morrow: Well, we’ve referred to the term neuroplasticity. It’s really just when there is, you know, an area that’s been damaged or an area that’s not there anymore in the brain, building a new roadway takes time. And that’s what neuroplasticity is, doing something over and over till you build that groove in the brain again so that there’s something new for the brain to communicate with

Phil Stieg: So I understand your uncle got you involved in your church band or a church band and that got you involved with music. And so what was the transition from loving music to all of a sudden wanting to be a neurologic music therapist?

Maegan Morrow: So my family, they’re all musical. And, you know, everything in our household was playing music, practicing, singing together. I grew up also in a very charismatic Christian environment, so I saw music doing some very interesting things to people in those crowds at church. And I knew that it wasn’t just spiritual.  And so I wanted to just first and foremost study music like, What is it? What why is this so amazing to us? Why does it work? My my mother was also in drug rehab and received music therapy and art therapy. And so I saw it work firsthand in my family.

And so I was just getting these glimpses of it. And when I started to study I realized, you know what? I want to help people and music is what I know, and someone told me that music therapy existed and it just totally clicked with me.

Phil Stieg: …the light bulb went off.  

Maegan Morrow: Yeah, exactly.

Phil Stieg: So what are your thoughts about all of the anxiety going on now with Covid and music therapy? As I was listening to, I was going I think everybody just needs listening to music on a regular basis and tapping their foot and taking a few deep breaths.

Maegan Morrow: Yeah, well, I mean, that is a big part of healing for me. I just, I’ll make a playlist or I might use music that’s matching my mood at the time. Like if I am very anxious, I’ll start there and just try to calm myself down over that time.

Phil Stieg: What I find amazing is I don’t like music in the operating room. I find that it distracts me. I mean, I like the music more than what I’m doing and it distracts me.

Maegan Morrow: Are you a musician at all? Have you trained?

Phil Stieg: I played the piano when I was growing up…

Maegan Morrow: Yeah, you probably ear-trained trained yourself so much that music could be more like a language to you. So I’m the same way. If I’m working on something like that, tedious, I’m going to be, my brain is going to be going back and forth trying to listen to the melody lines and then—

Phil Stieg: It distracts me, so I just don’t do it.

Maegan Morrow: Yeah, that’s smart.

Phil Stieg: So how is Gabby doing today? Have you seen her recently?

Maegan Morrow: I have seen her recently on TV the night of the DNC.

 (Crossfade to excerpt from Gifford’s DNC Speech)

Maegan Morrow: I heard that she’s playing music again. She’s learning Spanish again. she was such a determined person. She, she had a lot going on.

Phil Stieg: Maegan Morrow, a famous neurologic music therapist who worked miracles with Gabby Giffords and is down at TIRR Memorial Hermann Hospital in Houston, Texas. Thank you so much for being with us today. I think this has been fascinating and hopefully everybody’s going to hum a tune after listening to you.

Maegan Morrow :Thank you so much again. I had fun.

Phil Stieg: In the decade since her rehab treatment in Houston, Gabrielle Giffords has continued to make remarkable progress in her recovery and has continued to make music a central part of that process. In 2013, she and her husband, Mark Kelly, founded Giffords, an organization that has led a national effort in promoting gun safety and opposing gun violence.

Gabby Giffords: Stopping gun violence takes courage, the courage to do what’s right, the courage of new ideas.  I’ve seen great courage when my life is on the line. Now is the time to come together, be responsible. Democrat, Republican, Independent. We must never stop fighting. Fight, fight, fight!

Phil Stieg: She continues to be active in politics, having supported her husband’s successful campaign to become the next U.S. Senator from Arizona. Recently, she shared her thoughts on a recording made exclusively for our podcast.

Gabby Giffords: Long time ago, shot in my head, blind in one eye. Difficult words, aphasia. I don’t like it at all.

Interviewer: So can you tell me a little bit about what it was like working with Maegan and what your relationship was like with her?

Gabby Giffords: Maegan, really funny, really funny. Lovely, lovely, lovely, wonderful music therapy, really good stuff. Really good stuff. The body, the brain, a lot of homework.  (sings)  This little light of mine. I’m gonna let it shine. Let it shine. Let it shine. Let it shine.

I’m getting better, I’m slowly, I’m getting better… I’m getting better…

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