Thursday, October 23, 2014

Effect of Color-Coded Notation on Music Achievement of Elementary Instrumental Students

Effect of Color-Coded Notation on Music Achievement of Elementary Instrumental Students
George Rogers, Journal of Research in Music Education, January 1991, Volume 39, Issue 1, p. 64 - 73


This research study examined the use of color-coded notation on 92 grade five and six beginning band students. The goal of the study was to determine if using color-coded music would have any effect on the students’ ability to memorize music, sight-read or identify letter name notes. Divided into two groups from two different schools, the experimental group was given color-coded materials and traditional method books where the notes had been highlighted in different colors. The control group used the same curriculum, but non-colored. The results were interesting. Color-coding seemed to have no effect on the students’ ability to memorize music, but for sight reading, and in particular note naming, the research study did show that color-coding had an effect on a higher degree of test score accuracy. In addition to those results, the study highlighted the effect of color-coding on a special needs class and showed that it played a significant role in note identification. The study also revealed that 65% of students said that using color-coded notation made it easier for them to play. At the time this research study was undertaken, there had been no research done in color-coding in music education.

Color-coding as an educational tool has been well documented. The paper cites several research studies that showed using color-codes in numeracy and literacy materials improved performance results and test scores. According to Rogers, the brain responds well to color as a learning tool because “stimuli received through several senses excites more neurons in several localized areas of the cortex, thereby reinforcing the learning process and improving retention”. In other words, the brain gets excited by colors and this results in better learning.

In the beginning band classroom the ability to read simple notation and letter name notes is often challenging; especially for the special needs child. The black and white language of sticks and circles squeezed into a five line staff can be overwhelming to students who don’t process information as quickly and efficiently as others. Color-coding, as the study reveals, has been used over the years in various subject areas.  Students take for granted the colorful Venn diagrams and graphs of math and science text books.   I remember being engaged by colorful math textbooks from the 70’s and the colored letters of the alphabet on Sesame Street.  It seems logical that colors applied to numbers or letters could also be a beneficial pedagogical aid in music and score reading.  If B on the third line of the staff is pink but A on the space below is orange, one would think that at the very least, students would be able to identify and understand that these are two different notes, and therefore, two different sounds.

In my own work with learning differentiated students, I am using numbers to identify the notes of the B flat scale. I am intrigued by the possibility that using colors has the potential to reinforce the different notes, particularly if I use color in the early stages and continue to use color as I transition to the actual note names. In the study, special needs students did well when they were tested with color-coded notes, and became highly dependent on this system. However, they resisted being tested with non-colored notation, some refusing to even try. This raises concerns that color coding and in extension, non-traditional score curriculum could have a negative impact that might restrict or impair score reading as students advance to higher grades in music education. 

Questions that were raised for me after reading the study include;  What influence did using two different teachers for each group of students have on the final results? How did the application of “coloring in” the notes in a regular method book influence the learning? Would color-coding work more effectively on curriculum if it were designed specifically to be used in this way?

The final summary of the study reveals that no significant benefit was found in using color-coded notation. However, recommendations do include the potential of using color-coded materials with special needs students. It does highlight the result that 65% of students believed color-coded notation helped them play better compared to non-colored. I think this shows potential and leaves me wondering if there is value in taking another look at using color-coding in music education under different research parameters.


Tuesday, October 21, 2014



Voice and Choral Singing Treatment: A New Approach for Speech and Voice DIsorders in Parkinson’s Disease 

Source: Di Benedetto, P., Cavazzon M., Mondolo, F., Rugiu, G., Peratoner, A., & Biasutti, E. (2009). Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson’s disease. European Journal of Physical and Rehabilitation Medicine, 45 (1), 13-19. http://myaccess.library.utoronto.ca/login?url=http://search.proquest.com.myaccess.library.utoronto.ca/docview/67423449?accountid=14771

Summary:
The purpose of this study was to develop a new rehabilitation program based on voice and choral singing treatment (VCST) for those suffering from Parkinson’s Disease (PD).  Whereas the Lee Silverman Voice Treatment (LSVT) achieves speech rehabilitation by improving vocal fold vibration in order to increase vocal loudness, this method uses speech therapy and choral singing combined.

20 PD patients (13 males and 7 females) received 20 hours of speech therapy (one hour, twice a week) and 26 hours of choral singing (two hours, once a week). Speech therapy was administered first, not to improve speech and voice abilities, rather, to prepare and teach patients choral singing techniques. This consisted of “oro-facial-neck-shoulders-muscular relaxation, respiratory exercises to improve pneumo-phono-articolatory coordination to facilitate diaphragmatic respiration, laryngeal exercises to improve pathological hypo/hyperkinesia, oral and facial exercises to improve vocal tract movement, prosodic exercises by stimulation particular situations like speaking emotions of sadness or happiness.” Participants were then taught to sing popular and liturgical chants with piano accompaniment, thereby enhancing rhythmic stimulation. 

All patients underwent pre- and post- assessments which consisted of neurological, otolaryngological and respiratory function evaluation. The neurological assessment was done through an interview where neurologist experts gathered patient information on drug therapy, disease history, their response to levodopa and demographic variables. Experts also used the Unified Parkinson’s Disease Rating Scale (UPDRS) two weeks before, and two weeks after treatment period to obtain information about the patients’ mental state, daily living and motor function. 

The otolaryngological assessment included laryngeal videostroboscopy before and after treatment to evaluate the amplitude and regularity of vocal folds movement, glottic closure, and the symmetry of their vocal folds vibrations. Maximum phonation time was also evaluated by having the participant sustain the “A” vowel for as long as possible on one breath. This was done three times, with the best of all attempts recorded. Vocal samples were recorded for voice analysis. Otolaryngological assessment was done before and after speech and voice treatment. 

Lastly, researchers gathered information on the patients’ respiratory function such as lung volume and airway resistance, spirometry with flow-volume loops, and maximal inspiratory and expiratory mouth pressures. As with maximum phonation, the best of three attempts was recorded. 

The results showed significant improvements in prosodia, functional residual capacity, phonation, maximum inspiratory pressure, and maximum expiratory pressure. The authors have concluded that VCST has delivered positive results – it can be used for long period of time with good compliance. It is also cost effective and costs less money than LSVT. VCST also contributes positively to the patients’ quality of life, based on feedback from caregivers, although there has been no quantitative data to illustrate this. Although this study was a preliminary study, the authors state that VCST has shown to be an amusing and agreeable approach for PD patients with speech and voice abnormalities, however, a randomized control trial is needed to further examine the benefits of VCST.

Reflection:
This study has demonstrated that singing can help PD patients. Singing has proved to be a great resource especially considering that at least 75% of PD patients have speech abnormalities, yet only 3-20% have gone to a speech and language therapist. Singing not only helps speech abnormalities, but also can create social support if singing in a group, improve mood, anxiety, stress, and one’s quality of life. It is accessible to everyone, is cost effective and as this study has shown, is enjoyable to many.
Music never ceases to amaze me. Though it has been known that music has many benefits, it is incredible to see how powerful it really is – that it can help those with neurological disorders. This study was one example of the many disorders and symptoms that music can help alleviate and I am excited to learn what else music can do. I am sure there is a place for music in all things. Although I am primarily a pianist, I can understand the value of singing. It is great to know that although not everyone may be a musician, every individual has the ability to take part in music through singing.

Infant Sleep Machines and Hazardous Sound Pressure Levels


Source:
Hugh, S., Wolter N., Propst, E., Gordon, K., Cushing, S., Papsin B. Infant Sleep Machines and Hazardous Sound Pressure Levels, Pediatrics, 2014, Volume 133, Number 4.

Summary:

In this paper the authors aimed to quantifying the maximum output levels of 14 different models of infant sleep machines (ISMs) commercially available in the United States and Canada. The study was initially motivated by health concerns, since the consistent use of these devices, which produce ambient noise or noise, can possibly induce hearing loss in babies, especially when used at high output levels.

Methodology consisted of measuring ISMs´ sound levels at 3 distances (30 cm, 100 cm and 200 cm) using a sound level meter in a sound booth. Both ISMs and sound level meter were placed in tables of equal height, and the sound level meter microphone was fit a 2 mL coupler in order to simulate the human external auditory canal, and to assure that measurements were considered where the tympanic membrane would be in humans. Each machine was turned up to maximum volume, and 3 trials of 30 seconds were performed for each sound. Correction factors were made for the differences in resonant properties between the 2 mL coupler and the infant´s ear canal.

Results indicated that “for all sounds, effective output level decreased with increasing distance”. The mean maximum effective output levels at 30, 100 and 200 cm were 79.1 decibels (dBA), 70.5 dBA and 63.3 dBA, respectively. Three ISMs were capable of producing noise higher than 85 dBA at a distance of 30 cm. Furthermore, all 14 ISMs were capable of producing noise higher than 50 dBA at distances of 30 and 100 cm.

As a conclusion, researchers addressed the need to monitor and limit the exposure of infants to ISM devices, which may place them at risk of developing noise-induced hearing loss or imperfect development of the auditory system.  Authors highlighted that infant specific noise exposure guidelines for hospital nurseries and neonatal intensive care units are limited to 50 dBA measured over 1 hour. In the present study results showed that at 30 cm and 100 cm distance, the maximum output of all ISMs exceed the recommended limits. Nevertheless, authors also stated that ISMs can be used safely with policy recommendations for both manufacturers and families. Therefore, it is suggested to “place the ISMs as far away as possible from the infant and never in the crib, play it at low volume and for a short duration of time”.

Reflections:
As a child psychiatrist I enjoyed reading this paper since the topic is relevant for infant´s health: sleep.

In the introduction, Papsin and his colleagues described for what purpose infant sleep machines have been designed for (such as to provide ambient noise and to prevent arousal from sleep by masking disturbance environmental sounds). However, to my opinion they failed to explain the difference between noise and white noise, and how noise is perceived by the infant´s brain.  Nonetheless, the authors mentioned the potential deleterious effect of noise on the physiologic state and hearing of infants, which can influence both the quality and quantity of sleep.

One of the drawbacks of this study is that it was not performed in infants. This is understandable, as the time span required to design, execute a cohort study for infants and disseminate results would take long, whereas the main concern of authors were to warn scientific community and society about the risk of these devices and to recommend a quick and safer use. I consider that the future studies to be performed in children exposed to ISMs noise should control the proximity to ISMs, type of noise, volume intensity, duration of exposure and audiometric evaluation. Nevertheless, outcome will also depend on individual variation in tolerance of noise.

Overall, I understand the increasing popularity of the infant sleep machines, as parents would prefer to use them as a non-drug method to soothe their babies to sleep. Sleep disturbances are very frequent in infants and I believe that it is perfectly normal that caregivers are looking for the best way to help their children. Touchette et al. showed that sleep duration within the first 3 years of life is associated with hyperactivity/impulsivity and lower cognitive performance on neurodevelopmental tests at 6 years old. This finding highlights the importance of sleep in brain development and academic performance. The more knowledge science reveals about the importance of sleep, the more parents become stressful to avoid and solve the sleeping problems of their babies.

My other concern is how readily infant sleep machines have reached the market without undergoing a regular approval or oversight by health authorities. However, this research has been very important in raising public awareness of the potential harm of exposing infants to ISM’s loud sound level output and providing policy recommendations for a safer use.

References:
Hugh, S., Wolter N., Propst, E., Gordon, K., Cushing, S., Papsin B. Infant Sleep Machines and Hazardous Sound Pressure Levels, Pediatrics, 2014, Volume 133, Number 4

Touchette et al, Associations Between Sleep Duration Patterns and Behavioral/Cognitive Functioning at School Entry, Sleep, Sep 1, 2007; 30(9): 1213–1219.

From singing to speaking: Why singing may lead to recovery of expressive language function in patients with Broca’s aphasia

Schlaug, G., Marchina, S., & Norton, A. (2008). From singing to speaking: Why singing may lead to recovery of expressive language function in patients with Broca’s aphasia. Music Perception, 25 (4), 315-323.

Summary:

The authors used two patients with similar impairments and stroke size/location to contrast the behavioural and neural treatment effects of Melodic Intonation Therapy (MIT) with a control intervention using Speech Repetition Therapy (SRT). Both patients had nonfluent aphasia, resulting from lesions in the frontal lobe, including Broca’s region in the left frontal lobe, and were randomly assigned to treatment type. Most patients with Broca’s aphasia are treated by speech therapists in the subacute and chronic phases, using interventions to help recover language and facilitate communication. Routes to recovery involve recruiting either undamaged portions of the left-hemisphere language network, homologous language-capable regions in the right hemisphere, or both. MIT is a structured intervention capable of engaging both hemispheres, with its use of intoned patterns that exaggerate normal melodic speech content at three levels of difficulty, while simultaneously tapping each syllable with the left hand to prime the sensorimotor and premotor cortices for articulation.

The between-treatments comparison of the two patients showed that the patient treated with MIT had greater improvement on all outcomes than the patient treated with SRT. The unique contribution of MIT therapy is through the sustained vocalization of melodic intonation as well as the tapping with the left hand. Facilitating effects of MIT may be due to reduction of speed, syllable lengthening, syllable chunking, and hand tapping. Perception of musical components, such as melodic contour and/or meter, require more global than local processing; greater right-hemispheric brain region activation has been shown in tasks involving global processing. (The patient treated with MIT had significant changes in a right-hemisphere network, as revealed through an fMRI, involving premotor, inferior frontal, and temporal lobes.) Furthermore, rhythmic tapping may engage a right-hemispheric sensorimotor network that coordinates hand as well as orofacial and articulatory movements. Left hand tapping may also facilitate production of speech through rhythmic entrainment, anticipation, and auditory-motor coupling.


Response:

I first became interested in the effects of music on the brain when observing a family member, diagnosed with dementia and stroke, recalling and singing lyrics to songs that hadn’t been sung in decades, even though the family member hadn’t been able to speak for some time. How was this possible, both from a memory and language production standpoint? I was mystified by this discovery, which I have since learned has been documented on numerous occasions. Apparently MIT was developed based on a similar observation. In this study, both patients were a year post stroke onset, yet significant changes in the brain were revealed through neuroimaging following MIT. It shows the potential of the brain for neurorehabilitation, even after a significant amount of time has lapsed. Some of the interventions, such as tapping each syllable on a person’s left hand, are so easy to administer, yet can have such far reaching consequences,  given links between sensorimotor network, articulatory movements, and linguistic expression. I realize there are strict patient selection criteria for the use of MIT - it is not a suitable protocol for every patient with aphasia; however, there is still significant potential for its use in facilitating language recovery in patients who fit the criteria, a potential which has yet to be realized in our medical system.

Music evoked autobiographical memory after severe acquired brain injury

Baird, A., & Samson, S. (2014). Music evoked autobiographical memory after severe acquired brain injury: Preliminary findings from a case series. Neuropsychological Rehabilitation, 24(1), 125-143. doi:10.1080/09602011.2013.858642

Summary:

This study analyses the relation between music and autobiographical memories in subjects who had acquired brain injuries ABI. The concept of Music evoked autobiographical memories MEAMs refers to the ability of a person to recall specific memories while listening to very specific songs. This concept has been already explored by several authors, especially with patients with Alzheimer Disease (Janata et al. 2007, El Haj et al. 2012). This is the first study that focuses in people with brain damage caused by accidents.

Baird and Samson selected 5 subjects with brain injuries caused by motorbike accidents, cardiac arrests, fall from building and a suicide attempt. All of them were carefully selected as well as other persons to be used as control subjects (wives or siblings with a close relation with the subjects). The selection process consisted in choosing people with similar characteristics in terms of age, the cause of the injury and severity, their musical “experience” and the type of memory impairment (anterograde: verbal/visual). They also evaluated their emotional state to know if they suffered anxiety, depression or stress. Only one person was in a deep depression but the rest were practically normal and other person had some musical experience (bass guitar player).

Each subject had to answer a questionnaire to rank the familiarity with the songs, their likeness, if they remembered some specific event, and if this memory was positive or negative. Each person had to listen 30 to 60 seconds of random hit songs from 1961 to 2010. Except for case 5 the rest of the patients experience consistent MEAMs. It was determined that the fifth patient had impaired pitch perception and even though he remembered and even sang some of the songs he did not reported any memory. The rest of the patients reported vivid memories related with a person or specific life event and were typically positive and sometimes neutral. In terms of the amount of memories evoked it was discovered that the severity of the trauma was not related with a low number of MEAMs, in fact patients with more severe traumas reported more MEAMs.

The authors recognize that more tests should be done before having a clear understanding of their results, nevertheless these preliminary results show that there is a promising potential for music to be used towards cognitive rehabilitation in patients with acquired brain injuries.

Reflection:

It is clear from this study and from previous studies in Alzheimer Disease patients that there is a very strong relation with MEAMs and the patient emotional status. Additionally, memories become more vivid and are recalled quickly with the auditory stimuli. In some cases where the patients had a connection with the lyrics of the songs this effect becomes even stronger. During the detailed analysis of case 4 the descriptions provided by the patient’s wife were extremely detailed and specific while his husband just remembered certain details. The authors do not provide an explanation to this phenomenon but it might be completely unrelated to the brain injury. This difference in recalling specific events might be just related with the person’s ability to remember details. Frequently, we hear about couples where the female remembers very clear details of a particular moment or event such as the clothes that were wearing or certain specific words or feelings while their partners remember vague details.

It will be also interesting to see if the patients have other responses to the music (i.e. Chills) at the time they recall the memories. It has been argued that the intensely pleasurable responses to music are strongly related with the limbic region (Blood and Zatorre, 2001). In three of the cases analyzed in this study the patients head impacted damaging certain part of the brain, therefore analyzing the relation with the stimuli and the brain activity would be helpful to determine the different evoked memory capabilities.


Going back to the fifth patient who clearly knew the songs but reported no memories and no familiarity, it is worth to notice the importance of pitch perception over the rhythmic or the lyrics. It would be useful to make another set of tests and modify the pitch of the songs to evaluate if patients with acquired brain injuries can still recall the songs and evoke memories. I believe that the relation between the previous musical experiences may also represent a drastic difference in the amount of MEAMs. Musicians not only trend to appreciate and hear more music, but they also trend to analyze it unintentionally therefore they might be able to recognize more melodies identifying them as familiar, nevertheless this possible increase in familiarity might not be correlated with likeness or with memories.

Anne J. Blood, Robert J. Zatorre (2001),Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion, Proc Natl Acad Sci U S A. 2001 September 25; 98(20): 11818–11823. doi: 10.1073/pnas.191355898

Monday, October 20, 2014

Creating Music Using Brain Waves: Just For Fun Or Clinically Important?


Creating Music Using Brain Waves: Just For Fun Or Clinically Important?

Source:
http://healthland.time.com/2012/11/19/creating-music-using-brain-waves-just-for-fun-or-clinically-important/


Summary: 

          Chinese researchers from the University of Electronic Science and Technology in Chengdu have been studying how to create music using brain waves. They are making music which could help accurate diagnosis of brain disorders and new treatments.
In the first experiment, lead researcher Jing Lu and her colleagues used electroencephalography (EEG) to take brain signals and transformed them into musical notes. They measured the height or amplitude of the waves taken by EEG to measure the pitch of the notes and the duration of the notes was determined by the length of airwaves. The average power change of EEG was used to calculate the intensity of the notes.
However, after creating the first composition, they realized that the result was not comfortable for human ear as a piece of music because the rapid change of EEG signal brought about lack of coherence of the composition.
Lu and her colleagues added another technique, “functional magnetic resonance imaging”(fMRI), which measures brain activities by detecting change of blood flows in order to complement EEG’s functions. The researchers mention that the combination of EGG and fMRI enables them to compose agreeable pieces of music evaluated by a panel consists of 10 musicians.
Lu says that her team’s final object is to discover the secret of the brain and she wants to examine if the music produced by brain waves is more efficient than the traditionally composed music for music therapy.
According to the article, some successful therapeutic effects of brain music were reported by the Department of Homeland Security’s Science and Technology Directorate. The neuroscientists of the department state that brain music can be effectively used to treat anxiety, insomnia and headaches. They assume that the notes produced by the brain waves strengthen brain’s relaxation and alertness function.
However, some people have questioned about the therapeutic effect of brain music. For example, David Sulzer, a neuroscientist and professor who has been interpreting brain waves into performing music since long time, doesn’t see concrete evidences which support the therapeutic effects of music by the brain waves. He emphasizes that creating music by brain waves opens a new way of making music, but we need more concrete evidence to use it for therapeutic purpose.

Reflection:

It is very fascinating that researchers have been interested in using brain waves as a therapeutic way. Surprisingly, the article introduces some successful cases as well. However, it was a little bit hard for me to understand how music composed by brain waves can rehabilitate brain disorders. In my understanding, brain disorders can be diagnosed by examining brain waves and I have some doubts about the way of transforming the brain waves into musical notes. Can the height of waves and the length of airwaves correctly represent the pitch and length of notes as a composer who creates a melody from the brain on the paper by using his or her hand?

This curiosity led me to find more information about Lu and her colleagues’ research and I was able to find some samples of brain music and graphs. They give us four music examples; two EEG music files and two EEG-fMRI music files. I listened to the four files. It is true that the EEG-fMRI music files were more coherent than the EEG files, but for me, both of them sound like serial music consists of clusters of notes and it is hard for me to believe that the files could give a therapeutic effect for brain disorders.

Listening the files gives me two ways of improving their project. Firstly, I believe that it is necessary to study about the “timbre”. When a composer creates a piece of music or a melody, he or she thinks about not only the pitch and the length of the notes but also an instrument which has appropriate timber. I believe that choosing appropriate timbre enables them to get more successful results. Secondly, having coherence of the musical syntax would be helpful for those who need the brain music treatment.

In conclusion, I think we need more concrete evidences in order that the brain music becomes a new treatment for brain disorder and researchers should find various ways of transforming brain waves into music more close to the traditional human made music.

References
"Scientists hear the music of your brain." Scientists hear the music of your brain. http://www.themunicheye.com/news/Scientists-hear-the-music-of-your-brain-2358

"Scale-Free Brain-Wave Music from Simultaneously EEG and fMRI Recordings." PLOS ONE:. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0049773
 

 

Sonographic detection of basal ganglia abnormalities in spasmodic dysphonia

Source:
U. Walter, A. Blitzer, R. Benecke, A. Grossmann and D. Dressler. “Sonographic detection of basal ganglia abnormalities in spasmodic dysphonia.” European Journal of Neurology 2014, 21: pp.349–352


Summary:
A voice disorder characterized by involuntary contraction or spasms of the vocal cords causing interruptions of speech and affecting the voice quality, spasmodic dysphonia is an extremely focal form of dystonia. The exact cause of spasmodic dysphonia (SD) is unknown, but “research has revealed increasing evidence that most cases of spasmodic dysphonia are in fact neurogenic or have to do with the nervous system.” The authors of this study/communication, knowing that abnormalities of the lenticular nucleus are a finding in dystonia, wanted to study whether Transcranial Sonography detects basal ganglia abnormalities also.

Fourteen patients with spasmodic dysphonia were studied – 10 women, 4 men, who had experienced the disease for 16.5 +/- 6.1 years, as well as 14 healthy patients. Transcranial sonography of the basal ganglia, substantia nigra and ventricles was performed bilaterally through the pre-auricular acoustic bone windows. Where the sonography is of benefit is that it can image blood flow in the major intercranial arteries rapidly, and non-invasively. An increased echo response was reported in the lenticular nucleus (LN) in 12 spasmodic dysphonia patients but only one from the group of healthy patients, therefore revealing that there was a correlation between LN hyperechogenicity and adductor spasmodic dysphonia.

The authors discuss the idea that the extent of the correlation between the two – the severity of spasmodic dysphonia, “conforms to the idea that copper accumulation might directly influence symptom severity…copper accumulation in the LN could explain disinhibition of the thalamus via disturbed functions of neurons of the globus pallidus internus.” Studies have also shown that there is a reduction of the copper-transporting protein, Menkes, in the basal ganglia in dystonia patients.

Through digital analysis, the area of lesions revealed a link with spasmodic dysphonia severity, allowing the researchers the chance to link the underlying pathology of spasmodic dysphonia to that of more widespread forms of dystonia. The larger the echo response on an ultrasound had a direct relation to the severity of the dysphonia.


Comment/Reflections:
Last year, the first year Master of Voice Performance and Pedagogy students had the opportunity to be instructed by Aaron Low (Speech Pathologist) at The Voice Clinic in Toronto. For eight, two hour classes, we not only studied the anatomy and function of breathing, the larynx, vocal folds, pharynx, vowels and articulation, but we also looked at voice assessment techniques and the possible causes of voice problems. When it came to discussing the possible causes of voice problems, we referred to “The Voice: A Medical Guide for Achieving and Maintaining a Healthy Voice” by Yolanda D. Heman-Ackah, Robert T. Sataloff, and Mary J. Hawkshaw. In chapter 7, they talk about Spasmodic Dysphonia, what it is, and that the most common treatment is an injection of botulinum toxin, simply because “traditional voice therapy is often not successful.”

As someone who is intrigued with the singing voice and of teaching singing, I believe it falls upon the instructor to know not only of various speech ‘defects,’ but to learn of how to recognize it, and of the treatments available. The things to look for include: in the more common adductor type of spasmodic dysphonia, a tight, strained voice quality, often characterized by excessive closure of the vocal folds during speech (abrupt starting and stopping of the voice), whereas the abductor type causes a breathy, whispering voice, un-phonated bursts. However, this book doesn’t state how it is caused. It only mentions that it is a neurological disorder. It is for this reason that this Journal Article titled “sonographic detection of basal ganglia abnormalities in spasmodic dysphonia” was an interesting read.

If you observe the ultrasounds, as well as the graphs, one is able to see that the area of lesions revealed on digital analysis a link with spasmodic dysphonia severity. In this instance, for those patients whose grade of spasmodic severity was higher, echo response in the basal ganglia would also be larger. And on the other end of the scale, LN hyperechogenicity was a lot smaller for a patient whose severity of spasmodic dysphonia was less pronounced. This clearly shows that there are abnormalities of the basal ganglia in spasmodic dysphonia patients. Also, the authors suggest, “copper accumulation might directly influence symptom severity.” As we may be aware, the Menkes protein helps regulate the copper levels in the body. With a reduction of the Menkes protein in the basal ganglia, there is an increased level of copper, which modulates synaptic function and acts as an inhibitor of several receptor types.

It is fantastic that discoveries (or hypotheses) like these are being made. Medicine and science advances when people look for answers and it seems this group of neuroscientists have made a link between the severity of the dysphonia and an increased level of copper. When a cause is discovered, it seems possible to find a way to diminish the problem. In this instance, perhaps we should look for a way to diminish copper levels, for not only does it have an affect on Spasmodic Dysphonia, but also on Alzheimer’s Disease and Wilson’s Disease.

As someone who is interested in the human voice, and who comes from a pedagogical background, to explore spasmodic dysphonia further through this study was absolutely fascinating. It seems like there is more research out there, as well as research that needs to be done. I look forward to being provided with more answers on this topic in due course.


Works cited:

Yolanda D. Heman-Ackah, Robert T. Sataloff, and Mary J. Hawkshaw. “The Voice: A Medical Guide for Achieving and Maintaining a Healthy Voice” Narberth, PA: Science and Medicine Inc., 2013