What happens when you give ukuleles to a group of neurologists? If they happen to be physicians from UT Southwestern, you get a band of self-described nerds who call themselves The Ukulele-lics and the Subcortical Band. If you’re wondering about the name, in lay terms, it is a play on the words “echolalia,” meaning “repeated speech,” and “subcortical band,” which is a malformation in the brain. 

These neurologists didn’t suddenly decide to trade in their lab coats for Hawaiian shirts: their newfound musical interest had a purpose. In a time when telehealth visits with doctors are outweighing in-person visits, the doctors needed to find a way to put their patients at ease in front of a computer screen and camera. While many of us have found we can successfully communicate with our doctors via telehealth, the patients of these neurologists face more of a challenge. Most are children and all have cognitive impairments such as autism or epilepsy. 

“Our patients, children and teens, are typically very delayed,” said Dr. Patricia Evans, director of Neurodevelopmental Disabilities Clinical and Residency Programs at UT Southwestern Medical Center.  “About a third to half of them have autism, but all of them have cognitive impairment of some sort. This is more than just attention deficit. These are kids who struggle to understand basic things. … The autistic kids especially are rude-gaze avoidant – they don’t look at you.”

 The doctors found that many of the patients were engaging even less than usual during their telehealth visits and not wanting to look at the camera. “The whole (key) is to find something … other than a human face to get someone engaged,” Dr. Evans said. 

A lifelong music student who plays a variety of instruments, Dr. Evans is currently a student at Frisco School of Music and Performing Arts. She found her patients responded well to music during in-person visits, so she decided to try it during telehealth visits. “It occurred to me that when I played an instrument for my kids, they get riveted, so I would start playing guitar. Then I found out if you use a puppet and you make the puppet talk, you start interacting with the child and, all of a sudden, they’re in the camera. Then I figured out if you (used) a ukulele, you could make up a song.”

Inspired by the success she had with music, Dr. Evans developed a formal research study that used various techniques, including a ukulele, to enhance telehealth visits. She approached Chris Duncan, owner and executive director of the Frisco School of Music and Performing Arts, about teaching ukulele classes to her UT Southwestern residents and colleagues who volunteered to participate in the study. “She asked us if we would partner with UT Southwestern,” Ms. Duncan recalled. “I said, ‘Are you kidding? We would love to do that.’”

Earlier this year, before the online classes began, Dr. Evans taught the neurologists how to tune their ukuleles. “She prepped them once they got the instruments,” Ms. Duncan said. “She met with the doctors to give them a few pointers just to get started. Then our wonderful teacher, Mr. Andrew [Greear], who happens to be [Dr. Evans’] guitar teacher at the school, put together exactly … what could help the doctors in just a few short classes. They ended up learning the basics – how to tune and hold the instrument and reading simple tablature.”

Dr. Rana Said, director of the Child Neurology Residency Program and the Pediatric Neurology Education programs at UT Southwestern, was among the participants. An internationally known specialist in children’s epilepsy, she described a conversation she had with Dr. Evans about engaging children during telehealth visits. 

“She was telling me how it actually was very organic,” Dr. Said recalled, “and how that with Zoom and her patients that have autism, she would just instinctively show the patient some of her musical instruments. … She just kind of spontaneously picked up the guitar and would sing a very quick little song or what have you. I said, ‘Pat, that is such a wonderful idea. I wonder if this could be a research project?’ And then she took off with it. She developed every part of the science, what it was going to look like, the different toys that we might use and the ratings scale. Then the next thing you know, we were getting invitations to get ukulele lessons.” 

 Mr. Greear, at the Frisco School of Music and Performing Arts, taught the lessons via Zoom. “I taught four classes in total – two separate groups of six students each. It was such an amazing experience. By the end of the first lesson, we had already played four or five songs. By the time we were done, we had, I would say, at least 10 songs that we could play within two lessons. They all practiced and did their homework, and it was amazing.”

The neurologists took their ukulele training seriously. “I was very intimidated,” Dr. Said admitted. “What made it nice was that it wasn’t like a class for general instruction. It was all my trainees, our colleagues, the people that we knew and loved, so there was a strong non-judgment vibe.”

“They just absolutely had a ball,” Ms. Duncan said. Mr. Greear “made them perform at the classes for each other, and of course they’re all nervous but … it brought them out of their shell. They’re all laughing. He said they were even dancing at one point.”

“They’re all such great people and it was fun just to kind of get to relax,” Mr. Greear said. “These doctors have been going through quite a lot” during the COVID-19 pandemic. “To have a couple of minutes to sit down and play some music and just take their minds off of a bunch of other things that are going on was really refreshing.” Ms. Duncan echoed that sentiment. “We’ve all heard about how the essential workers have been completely stressed with not only what they’re doing, but what they’re seeing in the hospital environment and all the long hours. It was just this huge stress reliever.”

Dr. Evans said, “I think the take-home point is that acoustic music is therapeutic both for the player as well as for the receiver. I was so delighted that there was such a positive response among my colleagues and residents to learn the ukulele, to approach something brand new in the midst of a pandemic when everything was hard.”

The research project has already shown positive results. “I got to try it on a four-month-old (child) all the way up to a 12-year-old and all the ages in between,” Dr. Said shared. “It’s been really lovely because to see the children responding is magic.”

Also a professor of pediatrics, neurology and psychiatry, Dr. Evans summarizes the study this way: “A bunch of neurologists learned how to play the ukulele so we can engage better with our cognitively-impaired children. Preliminary data is very supportive of the use of musical instruments, certainly for telehealth, but it also works its way into personal visits as well.”

This summation is not just conjecture: According to the American Music Therapy Association, research has indicated that music therapy is highly effective for improving communication and interpersonal skills in young children with autism spectrum disorder (ASD). It also enhances auditory processing and motor skills. Other benefits include increased attention, improved verbal skills, improved cognitive function and decreased agitation. 

“We know the kids who study music when they are young … do much better long term in math and English than other kids who did not,” Dr. Evans explained. Also, “We know kids who have refractory epilepsy seizures, who listen to one to two hours of Mozart a day, in at least half of them, their seizures will fade, and their aging normalizes. The impact of music on the brain is profound. Music is miraculous.”

Diann Nichols is a freelance writer, a music lover, an armchair traveler and an amateur photographer who never tires of learning something new.