I consider it a privilege to be able to witness and play a part in The George Center’s Singing with Parkinson’s – a therapeutic choir designed specifically to address the needs of people with Parkinson’s disease (PD). It has been less than a year since the start of the choir, and yet the impact it has had on its members to me is impressive and exciting. Many think of Parkinson’s as a motor disorder – which it is! – but “motor” encompasses more than just the movement of your fingers, arms and legs. Speech is a motor function, along with breathing. In addition to motor symptoms, people with PD often battle apathy and depression. A therapeutic choir is a wonderful way to address all of these issues! Do not take my word for it. Let’s look at the research.
In addition to discussing their own study, Yinger and LaPointe talk about the needs of people with PD and present compelling points from previous research in their article “The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson’s Disease.” A common speech symptom associated with PD is hypokinetic dysarthria, which makes their speech softer, more monotone, hoarse and unclear. Additionally, people with PD experience lower vocal range and voice arrests. Thus, speaking can be a struggle. Multitasking can also be difficult and even dangerous (p. 26).
Thus far, the most effective treatment for speech impairments of PD has been speech therapy, specifically the Lee Silverman Voice Treatment (LSVT). Yinger and LaPointe suggest that the success of the technique is largely due to its five principles that promote neural plasticity: (1) intensity, (2) complexity, (3) saliency of treatment, (4) “use it or lose it,” and (5) timing of the intervention (p. 26).
Music therapy, however, is emerging as another effective treatment modality. Music therapist Haneishi (2001) began developing a music voice protocol (MTVP) based on the same principles as LSVT to improve the speech characteristics of people with PD in individual sessions. The 60-minute protocol includes opening and closing conversation, facial and breathing warm-ups, vocal exercises, singing exercises, practice sustaining vowel sounds, and speech exercises. Both Haneishi and another music therapist, Perez-Delgado, who adapted MTVP for Spanish-speaking individuals with PD, found that the treatment “increased breath control, voluntary speech production, and voice volume” (p. 28). Other music therapy studies have found a background of singing can delay the age-related decline in speech skills; that stimulative songs decrease the rate of speech while sedative songs improve “rhythm, initial consonants, final consonants, and continuity of speech”; and that singing can improve intelligibility of speech, as much as 21% (p. 27).
Yinger and LaPointe in their study used MTVP in a group setting and found improvements in intensity (loudness) of speech, especially in men, and prosody of speech in conversation in women, in spite of the progressive nature of the disease! (p. 29-30).
Looking at how these ideas relate to The George Center’s Singing with Parkinson’s choir, I see Claire Morison, who currently directs the choir, does an excellent job at incorporating the research-based format and techniques into the weekly rehearsals. These are things that I will need to keep in mind if I ever have the opportunity to lead a choir with a similar population. For example, I will need to make adaptations during rehearsals to accommodate for the needs of individuals with PD, which may include limited mobility, impaired vocal functioning, and potential neuropsychiatric complications related to PD or the medications used to manage the disease. Because multitasking is difficult and potentially dangerous, I may need to simplify tasks for choir members so they can focus on the quality of their singing. Multitasking is typical in the choir setting, such as when flipping through music while reading lyrics and singing. Hence, Claire displays the lyrics and music on a TV, at times scrolled by an assistant to eliminate the need for visual tracking. Lastly, I will need to be familiar with the vocal changes that may occur as a result of age and disease.
There are always ways we can make something good even better, especially as the choir continues to grow and thrive. For example, the fourth principle of neuroplasticity mentioned above, “if you don’t use it, you lose it,” emphasizes the need to regularly practice speech skills. In LSVT, clients are sent home with homework and exercises. In our choir, perhaps sending our members home with a recording of the accompaniment to vocal warm-ups as well as music in print to practice may encourage them to continue practicing at home and hopefully further aid in slowing the decline.
Yet to me, the most unexpected and impressive benefit of the choir is the emotional enjoyment it brings to the clients and their families. I am sure most of the appointments that our clients must attend on a weekly basis can be tedious and discouraging. We encourage caretakers to join in on rehearsals, elevating the choir to more than a therapy but also a socially enriching activity that can boost their confidence in their existing abilities. It is heartwarming to watch as choir members linger after rehearsals, talking and joking and sharing their stories with one another. Music does not just treat the physical ailments but the whole person and community. More than that, the choir gives clients a sense of achievement in ways they did not think still possible. One client commented that the choir has allowed him to sing again, a gift that he thought he had lost forever. Now, one of the major sources of his joy is within reach again. He is not the only one. Many have thanked us for the choir saying, “You don’t know how much it means.” Such moments are priceless.
Yinger, O. S. & LaPointe, L. L. (2012) The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson’s Disease. Music Therapy Perspectives. 30. 25-31.