On this episode of the Dementia Spring Dialogues podcast host, Dr. Marc is joined by guests Rachel Francine and Andy Tubman. Rachel and Andy are sibling entrepreneurs who discuss their company, SingFit, and the idea of music as medicine.
The episode begins with Andy and Rachel sharing some of their background experience in music and business. Andy is a music therapist, who began his trajectory in college when he played music for a friend recovering from an injury. It was at the hospital, where he was introduced to the music therapist on staff, and that experience inspired him to become a board-certified music therapist. Rachel’s background is more in technology, assisting companies who previously had a brick and mortar process and help them scale their businesses digitally.
Dr. Marc asks Andy to explain the science behind therapeutic music singing, and the difference between passively listening to music and actively making it. In the passive music experience, the brain lights up in a receptive way. When you’re making the music, it’s not just the receptive parts of the brain reacting, but globally, the brain is engaged. When you’re singing your thought patterns in the brain are being organized, and releases good chemicals, like serotonin to the brain. It’s this science that informs their SingFit technology. The heart of their company is in their app that hosts hundreds of songs. They also have SingFit Prime, a music therapy solution for groups that can be implemented with no prior musical experience. Now, SingFit is at over five-hundred senior living facilities.
As the episode ends, Dr. Marc asks them to identify some of the challenges they faced when they began SingFit. For Rachel, it was licensing the music, while Andy struggled to conceptualize to teach folks without a music background to utilize music therapies. Both Rachel and Andy also share some of their favorite SingFit success stories as well as exploring where they would like to see the company move in the future. This includes everything from scientific studies to international partnerships.
Links:
Learn more about Rachel and Andy
Learn more about SingFit
Learn more about Dementia Spring. You can find information about Dr. Marc and the Dementia Spring Dialogues podcast, and don’t forget to sign up for the Dementia Spring newsletter!
Marc: Welcome to Episode 2 of Dementia Spring Dialogues, where you'll hear from physicians, scientists, entrepreneurs, and thought leaders about innovations in aging, dementia, and caregiving. I'm your podcast host, Dr. Marc.
Today's episode features my lively dialogue with sibling entrepreneurs, Rachel Francine and Andy Tubman about the idea of music as medicine, the importance of singing for brain function and organization, and how their father's love of opera jumpstarted a tremendous journey into health care and dementia. Rachel and Andy are the founders of SingFit, a technology platform that expands the ability of people to access the proven benefits of therapeutic music, most importantly, singing, to improve their health and their wellbeing.
Andy has over 15 years of experience as a certified music therapist, one of only 7000 licensed in the U.S. Rachel is a technology and media veteran whose specialty is helping companies move from brick and mortar operations into the digital world.
Please welcome Rachel and Andy to the podcast.
Great to have the two of you here on Dementia Spring Dialogues. Thanks so much. It's really my pleasure to have both of you here. I'm really excited to be able to spend the next 30 or 40 minutes talking about what makes singing and SingFit so special when it comes to helping people with dementia.
But first, I'd love for our listeners to learn a little bit more about the two of you. How you came to be working on music, dementia, and now SingFit, specifically, and how it's so unique. If you don't mind, let's start with you, Andy. Where did you get your start down this path of therapeutic music?
Andy: Actually, I got into it because a friend went through a windshield on the first day of college, and he didn't show up. That ended up—I hadn't been interested; I didn't even know what music therapy was at that point. He ended up in ICU, unconscious and through pneumonia and all different kinds of serious trials; a couple of months later, he came out of the coma, mouthing the words to a Pink Floyd song that I had started to learn on the guitar. And everybody in the room was like, tears. The nurse was like, "I think you should talk to our music therapist." It at Einstein in Philadelphia. They had a part-time music therapist, and literally, I auditioned and got into the School of Music Therapy at Temple the next month and a half later.
Marc: That is an incredible story. Thank you for sharing it with us. As a physician, I can really relate to what such meaningful moments are like when you're alone with patients, and magic just happens.
How about you, Rachel? Was your path also through music?
Rachel: No, Andy pretty much took up all the musical talent from our dad. I can carry a tune, but can't pluck melody out of the air the way Andy can. My background is technology, so he got my dad's musical ability. My dad was used to be called a crazy inventor and is now called a serial entrepreneur, but I really took up that side of his personality and started working on the internet quite early, so '96, and always really help companies like CitiSurge or the Dallas Morning News or cars.com take what had previously been a brick-and-mortar process and figure out how to scale it digitally. That's, for me, is what is interesting in addition to the neuroscience and all of the stuff around music as medicine that fascinates me, the idea of how do you take this thing, which previously had been very limited. There are only 6999 other certified music therapists in the country besides Andy, so 7000 music therapists, it's really hard to get therapeutic music out to people. For me, I was figuring out how to digitize that so other kinds of health care professionals and [Inaudible 0:04:42] caregivers and even individuals themselves can use music as medicine. That's really where my background comes into the picture of figuring out how do we take what's inside of Andy's and our music therapy team's heads and their knowledge and figure out how to get that out to more people every day.
Marc: So, two very different, very unique journeys into health care and into dementia from what I'm hearing, but I sense there's a common theme: your father. You said, Rachel, he was a crazy inventor, otherwise known as a serial entrepreneur, I suppose. But am I right? He was also an amateur opera singer, wasn't he?
Rachel: Yeah. [Laughs] So, he was an opera student. While he was alive, if we said he was an opera singer, he would always correct us and say that he was an opera student. The core technology that we use in our business is this thing called "lyric prompting" or "lyric coach." What Andy discovered when he went to college for music therapy is this lyric coaching where the words of the song are prompted to you right before you need to sing them, is an evidence-based music therapy practice. For example, Gabrielle Giffords' music therapist, when the congresswoman lost her ability to speak, they used it with her to get her singing, which then allows for brain plasticity to take over and allows you to regain your speech. But it's also a technique that's used in the opera. So, that's where my dad first stumbled upon it and really started this whole journey with the idea of a product for what he would call lazy singing students who wanted to practice on their way to their classes, so their teachers would think that they were more well-rehearsed than they actually were. That's how the journey all started was with my dad as this self-proclaimed lazy opera singer. His voice is on a couple of the tracks that we use for the program now, so he's still involved even though he's since passed.
Marc: That's just terrific. Thank you both for sharing those stories with us. I'm really interested in exploring the kind of evidence behind what people like Gabby Giffords are using to improve her speech and her function. But if I might take a moment, a shout-out to your dad. Was he ahead of his time or what?
Rachel: So, let me come up with a technology idea that can only be implemented about 60 years from now, and I'll have two kids who will help me fulfill—I will mold them to help me fulfill that dream. That's basically what my dad did.
Marc: Indeed, and the two of you are clearly making it happen.
Let's shift gears now and dive into the science behind therapeutic music singing and SingFit. Andy, you and I have talked offline about how there's a real distinction between passive listening to music and making music. How is that relevant for dementia in particular? I'd love for you to share your thoughts about that distinction.
Andy: In passive listening or passive music experience, the brain lights up certain parts of the brain to be receptive, in a receptive way, to understand and decipher the information and have the listening experience. How much the brain lights up and what parts of the brain are activating is dependent on the song, volumes, time of day, sonic quality—there are many, many elements to the engagement of the brain in the listening experience. With the neurologists really diving into the musical field, they've used F-MRIs and all kinds of technologies to see that when you are making the music and when you are singing, it's not just those parts of the brain that are lighting up when you're listening, but also, globally, the brain is engaged, like timing centers, motor centers, planning centers, short-term, long-term, subcortical, topical, the whole thing is fired up when you're actively making the music.
We're talking to a [Inaudible 0:09:16] care company, they say, "Well, we have an entertainer coming in." And then I say, "Well, that's great for the entertainer because the entertainer's getting all the work and the senior is sitting there on their rump and they're maybe getting a schtick and a little smile out of it, but what does it do long-term, quality of life, clinical outcomes? What does it really do for the senior?" By going to the active, that is what we have now learned, and especially in the senior world, it is really the way to go to really utilize music effectively.
Marc: When you put it like that, it seems very intuitive, this difference between passive listening and active singing, different centers of the brain being activated. It really makes me think of my own Aunt Sandy and her struggle with dementia. Her caregiver, Uncle Ira, has written, he's spoken about moments when the music is playing, and Sandy is saying, or the music is playing, and the two of them are dancing together, and he says, very eloquently, that at moments like that, dementia just seems to fade away. I'd love to hear your thoughts about that.
Andy: When you're doing this singing and dancing is just an extension, because when you're singing, you are actually motor planning on very many levels, everything from your breathing apparatus to the speech apparatus, timing centers, everything is getting planned to be organized in a grid, in a musical grid. [Clapping hands, singing] So, there's this musical grid that we're planning, and what that does is for everybody; it enables you to anticipate and fulfill expectations easily because it's music. You know when that chorus is coming around.
But what it does for people with dementia is that it helps to organize their processing, organize their cognitive processing, organize their physiological processing, and when someone is organized, their mood goes up because they're not scared. They're not feeling freaked out. Time isn't weird. That person isn't looking at me weird; we're singing together and smiling. And so, the organizational qualities of singing and singing together can be extremely powerful if applied right.
Marc: That is so interesting to think about how singing itself is organizing thought patterns in the brain and combining that organization with speech, with planning, as you said, perhaps with movement. That resonates for me as a drummer, but it also resonates with me as a geriatrician because I am often counseling families about the frustration that comes with being disorganized in the brain, and a lot of that is what people with early dementia are feeling, the speech might come, the thinking and planning might be there, the movement might be there, but they're not happening in sync. They're not on rhythm is the way I think about it.
But it's not just about organizing the brain from what you're saying. Tell me if I'm crazy, but it sounds like you're really describing something much more like aerobic exercise.
Rachel: This is really important: When you sing, you also release all the good neurochemical: Serotonin, oxytocin, endorphins, dopamine, and that can happen when you listen to music, but it is dependent on your emotional connection to the song. Whereas, when you are singing, it's better if you like the song just for your own enjoyment, but it almost doesn't matter; it's the act of singing like the act of exercise or doing yoga, whether or not it's your favorite yoga pose does not affect whether that yoga pose is actually helping you stretch, and it's the same thing with singing, it's just the very act of doing it that makes it powerful, brings in your respiratory system, brings in pretty much every part of your neurochemical system is getting activated positively when you're actively involved in the music.
Marc: So, we have singing as a way to organize the brain. We've been talking about singing as exercise. This is an amazing conversation.
Why don't you guys go ahead and tells us a little bit about what SingFit itself is and about your company?
Rachel: At the core of everything that we do is our SingFit app, and what that app does is really digitize that process that Gabrielle Giffords' music therapist used or that opera prompter used, which is it's an app, it has several tracks on it. It has the background music of popular songs, and so we have deals with Universal and Warner and Sony and all of the big music companies to get these popular songs. It has the background music, it has a lead singer, and then it also has this prompting track that prompts you the words to the song right before you need to sing them. Some people say, "I know every word to my favorite songs," and it's like, "Yeah, you know the first verse. Your third verse, you're going to get a little shaky there."
That’s where we start with everything, and we now have two products on the market. One is called SingFit Prime, and that's a group singing process for long-term care facilities. With that, we incorporate not only singing but a journey and a reminiscence process and a trivia process and all of these sort of different elements that really is going to engage somebody, especially with dementia. These are built out of best practices that music therapists have been using for years, but the combination of our technology and our training allows a person who is not a music therapist to be able to implement this one very specific slice of therapeutic music. We like to be really clear that what we do is not music therapy because music therapy can only be really implemented by a music therapist, and they have a whole toolbox full of tools that they would use.
Marc: You're saying that the staff in a senior living community, maybe the recreation therapist or an RN, could essentially put this theory into practice for the residents?
Rachel: What our clinical team and Andy, what they do is create these protocols and processes that get people singing on a regular basis and to go back to the exercise analogy, if you exercise once a month, it's a nice little endorphin rush that day, but it's not going to help you increase your heart health. So, we have recommendations of at least two to three times a week to be singing in just the same way that you would recommend that somebody exercise at least two to three times a week to get those benefits, and we create those protocols, so that happens and it makes it easy and turnkey for our clients to be able to implement that. We have training programs for inhouse staff at different kinds of health care communities and facilities so that they're able to implement the program. Our clients can have unlimited singing for their entire communities and residents for about the same cost that you would bring in a singer to entertain them four to five times a month. So, they're singing anywhere from 20 to 40 times a month, rather than sitting there and listening. I think that it's that regularity of the implementation that's super-important.
Marc: What you're saying is that it's active, more like exercise, and potentially cost-effective. I would think that assisted living facilities and nursing homes would be eager to pivot their music programs toward a more active program like this. So, I'm curious, how is the company doing with enrolling clients?
Rachel: We're at over 500 long-term care facilities now, and that really ranges from everything from Sunrise Senior Living, which is the third-largest senior living chain in the country, so we're at all 260 of their communities, which really was the proof in the pudding that we could scale this really well, and we've been there for over three years now, at all of their communities. But then we're also, for example, at [Inaudible 0:18:59] Community Hospital in Wyoming, which is this rural critical care access hospital where they have a small dementia unit, where they would never have access to a music therapist. So, to me, one of the things that we've shown is A, we can scale, and B, we can fulfill on that promise of telemedicine in that this actually can expand care to more people who wouldn't necessarily have access to it.
So, 500 communities was a nice mark to hit. We had to put a lot of pins on the map that day, but it was worth it.
Marc: First of all, congratulations on hitting that 500 facility milestone, that's great news. I'm thinking about your comment, how SingFit is a force multiplier for music therapists like Andy, who, like myself, were once treating one patient at a time, but now you can really impact hundreds of people, thousands of people at a time nationally. I'm curious, are there stories that stand out at the individual level when you think about the individuals, the people, the families that SingFit has impacted?
Rachel: There's a couple that hit me. One is, we were working with a community in California to do some videos. It's called [Inaudible 0:20:26] Back Palms, and we recorded a session, and there was a couple there, and the wife did not have dementia, but the husband did. We found out a little bit after that, a couple of months after that, that he had passed and we pulled some stills and some photos from the video, and we went back to give her the photo. She talked to us and told us it was the last time that he ever seemed like himself. It was the last time that she ever got to experience the him that she remembered really loved. We get story after story like that from families who attend the sessions and a lot of our communities. We had another person who actually ended up working for us for quite a bit who called me after her mother passed and said, "I'd been trying to get this particular community to get more music in," because she knew it would be good for her mom, and they finally did. They got SingFit, and she, again said, it completely changed her relationship with her mother and that she would schedule her visits around the SingFit sessions because she could interact with her mother in this loving and connected way that she wasn't able to beforehand.
Those and the stories of people who don't participate in anything else, but will participate in SingFit, those are my favorite stories. I don't know if I took all of them, Andy, or if you would like to add a couple more.
Andy: Last week, we had one session; it was a speech therapist working with a woman with Parkinson's. The patient actually her vocal volume, as often occurs in Parkinson's, was diminishing. This speech therapist was expecting to sing for five minutes. The session ended up going for 25 minutes, and the woman reported decibel levels when they were speaking and not singing, and she said that by the end of the session, the woman's speech was up 12-decibel levels. To me, the transference from the singing to the real world that's what excites me for sure.
Marc: You bring up a great point, Andy. The fact that behind any good entrepreneurial health care venture, there really needs to be evidence, clinical evidence that the intervention has an impact, as you mentioned. If you would, please share with us some of the research that you've already done and where you'd like to see that research perhaps go in the future.
Andy: We've had a bunch of white papers and small studies done, and what was very evident in all of the studies, actually, was the mood elevation that occurred during the SingFit sessions. The SingFit sessions consist typically of, obviously, the singing with the lyric coach, but it also consists of a storyline with a theme, trivia questions, exercising semantic memory and cues, and then movements, and self-disclosure questions. So, it's a whole program, especially for the group process. What that showed was 40% to 45% mood elevation per resident per session from memory care up to assisted living where people were typically [Inaudible 0:24:28]. So, the mood elevation over three or four legitimate-sized sample sizes of different communities and different companies really showed serious mood elevation. So, then it starts implying, were you able to transfer that in lower medication use or prn medication use? We've had some very interesting results on prn medication, as-needed medication, that you manage behaviors with. You could reduce some of that anxiety or depression meds and behavioral meds using singing prescribed at the right time of day kind of thing.
So, we've seen a bunch of very positive results. To do heavier, large, large sample sizes, like 5000, 10,000 people would be really exciting to us. We had some researchers, [Inaudible 0:25:33] Patel, who's a huge neuroscientist and one of the premier music brain researchers in the world, wrote a publication on SingFit, suggesting that this is the first time in history that delivery of the function of the singing process, the song learning, the delivery of the song learning is going to be the same for everybody and actually creates a standard control within a research project that now we can actually look at longitudinal studies with large swaths of people and see how singing affects people on a very large scale.
Marc: And how about work overseas? When I think of countries that are really forward-thinking about dementia and are often the earliest adopters of the new technologies that come along, I tend to think of the Scandinavian countries or England or Ireland. Any luck in those markets?
Rachel: We're working on it. We have a partnership with Glasgow Caledonian University. I think when it comes to dementia care, Scotland is one of the best countries in the world, really dealing with how they care of folks with dementia, and so we've been working on some projects with them to potentially do just what you're saying. Hopefully, by this time next year, we'll have some really good news around that.
Marc: I definitely look forward to hearing more about that in the coming years.
Let's switch gears now and talk about some of the challenges you've both faced as startup entrepreneurs because, as any starting entrepreneur knows, the challenges can come from unexpected directions. Let's start with you, Rachel. What kept you up at night as you were getting SingFit off the ground?
Rachel: From my perspective, I don't know if you can see it on the Zoom, but all the gray hair early on came from music licensing, was actually one of the most challenging parts of what we do. Yeah, getting the rights to the music is no easy feat, and so, for me, that was one of the biggest challenges. And then also, just really being able to communicate effectively with people about why singing and music as medicine is important and elevating that story. But we were very fortunate in that the timeline of the company has really coincided with more and more research around music as medicine. And so, we have to do a little bit less convincing these days, but still a lot of convincing, especially in the U.S. In the U.K. and other countries, there's more support for it from the health care industries in general in other countries. I don't know, Andy, if you had any particular challenges besides your first time really working in an office. I think that was one.
Andy: That was my biggest challenge. I wasn't rolling around on the floor with a 5-year-old autistic kid hitting drums; that was the biggest challenge. I guess it was figuring out how do you train people that don't have a music therapy skillset? How do you break it down? What are the salient features, the understanding, the strategies, and use them in an effective and ethical way that's going to have positive outcomes all the time? And so, what you put in the funnel is not necessarily what you expect to come out. I learned that and how to hone even what you're putting in the funnel before it goes in kind of thing. So, really a lot of the training and understanding who we're training for, that was kind of pretty challenging.
Marc: I can imagine that would be very stressful, Andy, trying to make those difficult concepts easier to use for a broad variety of audiences and instructors, essentially.
As to what's next for SingFit, my impression is you're expanding beyond just the group programming for residents of nursing homes and assisted living facilities, right? You're working to make therapeutic singing itself a tool that a licensed therapist could use, could put in their care plan, could bill for, and be reimbursed for, is that correct?
Rachel: Yes, now we have a new product on the market called SingFit Studio. This is a one-to-one product that could be used by speech therapists, occupational therapists, and we're rolling out to different kinds of health care professionals as well as [Inaudible 0:30:18] economy caregivers to be able to use this at first one-on-one with people with dementia, but then sort of, again, expanding out to be able to use with different kinds of health care challenges and conditions like Parkinson's and stroke.
Marc: How is that going so far?
Rachel: It's been going really well. It's fairly new. We just launched that about a week ago, and so we have our first three pilot tests going on. The product itself and the solution itself has been tested using speech therapists to implement it with people with dementia and Parkinson's disease. So, we had already tested our protocol and now the process—and we knew that it worked—and now the process that we're in is actually having those therapists use it as part of their billing codes and looking at how that is processed through the system. So far, the results we have, you know, it takes a little while. Any kind of systems check takes a little bit of time, especially with the government, but right now, it's looking really positive.
Marc: It seems to me like you are moving closer and closer to making the intervention of SingFit usable by individual caregivers in the home setting with their loved ones with dementia, is that right?
Rachel: We don't actually have a program for caregivers yet; this is one that we are getting ready to launch. If people want to be part of a beta test, however, they are welcomed to reach out to us at info@SingFit.com.
Marc: This has been a real treat, and to you, Rachel, and you, Andy, I just want to say thank you for making time to speak with the Dementia Spring community today.
Rachel: Thank you, Marc. We appreciate you having us on and really helping also, you know, we have a relationship with AARP, and part of that relationship is how do we amplify music as medicine overall, and this is part of that as well.
Marc: Before we go, how can people learn more about your company, the SingFit story, and any potential opportunities to learn more and get involved?
Rachel: SingFit.com is always a good place, and then all of our social is under, WeAreSingFit.com.
Marc: Well, folks, that bring us to the end of Episode 2 of Dementia Spring Dialogues. To our listeners, thank you all for tuning in. Don't forget to check out dementiaspring.org and sign up for our monthly newsletter. Rachel, Andy, it's been terrific speaking with you today. Thanks for making time for all of us.
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