Last week Arthur Kuck celebrated a birthday. His daughter brought ribs and cake, and trimmed his fluffy white hair. His friends sang "Happy Birthday" and gave him a round of applause. His wife squeezed his hand and said proudly, "Ninety-one."
Now, Kuck couldn't tell you about any of that. Advancing dementia has curtailed both his short-term memory and his ability to communicate.
"Sentences are becoming harder, if not impossible," said his daughter, Jane Frick. "He knows, but he can't verbalize."
But when he sits around the piano at Spring Mill Presbyterian Village, a senior living center in Lafayette Hill, surrounded by fellow choir members and heeding the cues of their 17-year-old conductor, Kuck's muscle memory takes over. Out of his mouth tumble lyrics learned years ago, and notes honed over decades singing for his church in Elmer, N.J.
"Have yourself a merry little Christmas . . ."
Music therapy has long been used for memory disorders. Research is beginning to show that making music can be even more effective than listening because it activates many different areas of the brain.
"Music is unique - you have this pairing of not just sounds, but the words and the movement," said Darina Petrovsky, a nurse researching the effect of music on memory-impaired patients for her dissertation at Penn. "Your brain has to pair the words with the sounds and the sounds with the instruments. In a choir, people are matching what they're seeing and they're matching with people around them."
Leah Schick first noticed the effect a few years ago, when her Plymouth-Whitemarsh High School choir performed at Spring Mill. So she offered to start one for its residents.
The initial response was hesitance. "It was just a lot of fear," said Spring Mill activities director Linda Suarez. " 'I can't do that anymore, my voice is gone, I don't remember how.' "
After 18 months of weekly visits from Schick, the choir has grown from about five members to two dozen - nearly a quarter of the residents. They perform in the dining room for staff, residents, and relatives.
"Now they're saying, 'I'm part of the choir!' You see that confidence and they get excited about it," Suarez said.
On Wednesday, they'll gather for their holiday concert, each clad in a shirt printed with their name: the Presby Singers.
The choir draws members from all stages of care. But once the music starts, it's nearly impossible to pick out the four who have dementia from those in independent living.
At last week's practice, Kuck sat in the middle of the room, next to the giant Christmas tree, his dark eyes focused on Schick.
The scene was reminiscent of many a school music classroom - the girls on the left who won't stop gabbing; the guy in the back whose head bobs with drowsiness; the flipping of sheet music and inevitable repeat question: "What page?"
Though still a high school senior, Schick has had years of training as a singer and violinist, and serves as concertmaster for the Montgomery County Youth Orchestra. She's relentlessly perky but runs a tight ship, using repetitive instructions and deliberate gestures to get them all singing in rhythm.
"Every time I go like this," she says, gliding her hand from left to right, "I'm giving you a note. So make sure to watch for that."
Her elders nod and grin when Schick bosses them around. Sometimes they hit back with sass.
"Have a lot of fun with this one," Schick said as they turned to "Frosty the Snowman."
"OK, you're askin' for it," Josephine Casalane, 90, retorted with faux menace.
Their smiles grow bigger when Schick joins them, her crystal-clear soprano reminiscent of Julie Andrews as she leads them through a Sound of Music warm-up:
"That will bring us back to doh-oh-oh-oh . . ."
"What a beautiful voice. She loves music, and she shares it with us," said Mildred Krausen, 96. "She's adorable, the sweetest young lady."
Some win more points for enthusiasm than for pitch. Others, like 86-year-old Earl Cunningham, provide a melodic tone and smooth foundation for the entire group.
At the Dec. 2 rehearsal, Cunningham arrived a little late, but started singing even before he was seated.
"Through the years, we all will be together / If the Lord allows . . ."
Jazzy, upbeat songs are more popular. As the group neared the end of a universal favorite - "For it's one, two, three strikes you're out at the old ball game" - Lin Kennedy raised her arms with a flourish.
"I love it!" she said, her smile so broad it looked as if it might topple her slight, 83-year-old frame.
Kuck (pronounced "Cook") is one of the wallflowers, but when spotted, he flashes a sweet smile.
"He doesn't sing loud, but then he never did," said his daughter, who picked Spring Mill for her parents in 2012 because it's around the corner from her home.
Her father worked for decades as a machinist, first in the Navy and later at the Arco refinery in Philadelphia. He can no longer work with his hands, but it seems he yearns to. When he enters a room, his eyes lock in on the first mechanical object in sight - an electric shaver, a remote control, an elaborate snow globe with separate controls to blink the lights, move the train, and play the music.
The extent of his memory loss became clear at a doctor's appointment a few years ago, when the doctor asked Gladys Kuck to stop finishing her husband's sentences. "She thought he wasn't saying it fast enough, so she was helping by finding the words for him," Frick said.
Now Kuck finds comfort in the familiar. So when she heard about the new choir, Frick signed her father up right away. She keeps a photo of Schick and the group on her phone, to show rather than tell him it's time to go to rehearsal.
"Sometimes the words don't sink in," she said. "When he sees that, the light will come on."
Diana Laventure, activities coordinator for the dementia ward, said choir practice also helps ease patients through "sundowning," an evening stretch when they may begin to get restless or search for something on which to focus.
"Depending where they fall on the spectrum, they might start wandering or looking for something to do with their hands," she said. "They might ask to go home, or go into other people's rooms, start touching things."
In the choral setting, Laventure said, "we're not seeing that behavior anymore. . . . So that tells us they are engaged."
The visits to Spring Mill have become a weekly expedition for Schick's family. Sister Anna, 14, accompanies on piano. Their parents, Darryl and Pam, help set up chairs and gather the troupe.
"Sometimes they come in and they don't remember their own names," said Darryl Schick, himself a music instructor. "But they remember all the words and when to breathe, and when to get louder and softer."
Leah Schick has been accepted to West Chester University for music education and is waiting to hear back from Temple. Staying close to home, she hopes, will mean she can continue to work with the choir.
But the future will wait.
For now, she is more concerned about getting her singers ready for the holiday concert.
"Fa-la-la-la-la, la-la-la-la. That's a lot of words, a lot of syllables. Really try to make it a definite L so they don't all mush together," she told them last week.
They didn't quite hit all of the high notes, but they did enunciate those L's.
". . . Sing we joyous, all together / Fa-la-la-la, la-la-la, la-la-la . . ."