Wednesday, October 1, 2008

Example of an entry

The following is what I consider and exemplary entry from previous blogs. Obviously length can vary.

Making non-fluent aphasics speak: sing along!
Catherine Robbins

Amelia Racette, Celine Bard and Isabelle Peretz. (2006). Making non-fluent aphasics speak: sing along! Guarantors of Brain, Oxford Journals Volume 129, Number 10. 2571-2584.

Singing if often used in the treatment of speech disorders. This treatment has spawned the development of Melodic Intonation Therapy or MIT. MIT is a rehab program “using high probability phrases and sentences which are intoned and tapped out in a syllable-by-syllable manner” in which rhythm is key. In an attempt to further assess the claim that aphasics can sing words they cannot speak, eight brain-damaged patients suffering from numerous speech disorders brought on by left-hemisphere lesions were studied. The authors justify the study by briefly explaining possible reasons that singing may improve speech in aphasics: it slows down word production by 50%, words that are learned through music are fixed or non-generative, melody may facilitate access to words because they are associated in memory. But, they add, supporting evidence is lacking. A number of studies with conflicting results have been conducted in the past. The concern is that classic reports that non-fluent aphasics may be able to sing “may reflect the disassociation between automatic speech (in singing) and propositional speech (in spontaneous speech).” Examining this issue in speech disorders was the goal of this current research. To this end, three experiments were part of the study.

Experiment One: Patients were tested in the repetition and recall of words and notes of familiar material, i.e. children’s songs and traditional songs of roughly 5 words and 9 notes long, two well-known prayers and one nursery rhyme. It was found that singing did not improve word production compared with speaking and notes were better produced than words.

Experiment Two: The patients repeated and recalled lyrics from novel (popular) songs. They did not produce more words in singing than in speaking. In fact, patients made the same types of errors whether singing or speaking. This suggests that the speech output is controlled by the same mechanisms.

Experiment Three: In this experiment an alternative strategy was explored - singing with the therapist before trying to sing alone. The patients listened to the songs through a headset that was equipped with a microphone. Presented lines fed through one channel and were time locked to the patient’s production that was recorded on the other channel of a DAT recorder. The patients could hear themselves but the authors admit “the headphones might have altered the auditory-feedback to some extent.” This time, more words were correctly articulated when singing along (M=63.2%) than when speaking along (M=50.5%). Six out of eight patients showed this result. Recall, pitch accuracy was better when shadowing than when producing tone alone. However, when recalling four lines without shadowing, speech was more advantageous. Therefore the conclusion may be drawn that singing “along” benefits word recall, while singing “alone” does not.

To reiterate:
“The main finding from the present study is that singing “per se” does not help aphasics to improve their speech.” The conclusion was reached regardless of whether the songs were familiar or unfamiliar. This suggests that there is a unique code for words regardless of whether they are sung or spoken. In this respect, this study confirms what earlier studies have already told us. However the researchers tell us, in experiment three a more interesting conclusion presents itself: singing in a group is better that speaking in a group. The authors note that the “singing along” advantage probably arises from the opportunity to synchronize one’s performance with a stable model....What seems to be critical is to be able to imitate in synchrony with an auditory model.”

The important conclusion was “the present findings point to choral singing as an effective therapy for various speech disorders. Choral singing may even account for the efficacy of the MIT in its initial stages.” The recommendation is that “future longitudinal studies should compare training with choral singing to explore if the advantage of choral singing has more long-lasting effects on speech recovery.”

As a choral conductor, when I read the results of this study I was thrilled. Choral singing is an musical therapy! I had read the opening line and then flipped excitedly to the “discussion” section you find in many brain research study articles. The last two quotes really got me going. I immediately began thinking about implications of the conclusions and possible cross-overs: Does this have implications with beginning readers? Can this be used in true interdisciplinary studies? Can we finally shout from the rooftops that choral singing is beneficial to the brain? Then I flipped back to thoroughly read the study. To my dismay, the researchers do not define “choral music”. As far as I can gather, their idea of the “choral singing” that the patients were engaged in was with the speech therapist in unison and through a lone female singer on headset that was played while they sang. So singing in synchrony with an auditory model seems to be the researchers definition of choral singing. This section of the experiment was poorly worded and the exact procedure was a bit fuzzy. However, this method of experimentation in no way fits the general definition of choral singing and is, in my opinion quite misleading. The heading of experiment three “production in unison” is a better fit, although it still lacks clarity. What this study really seems to be about is the benefits of audio-vocal feedback on speech disorders. Singers in any situation seem to respond well to singing with others. I often use it in private vocal lessons for all ages. Those who have tortured themselves with the first few weeks of American or Canadian Idol can surmise that many of these hopefuls sing along with the radio or a recording before entering the competition and being asked to suddenly sing acappella. We all know the disaster that results from this. Could this not be along the same lines as positive results and the assertion that the “opportunity to synchronize oneself with a stable model” is an auditory phenomena? Researchers have studied how auditory feedback helps people speak. A study at MIT in 1998 (Houde, 1998) spoke of the facilitation of helping persons with speech disorders through what they labeled their “internal model” of how speech should sound. It spoke of how we automatically begin to correct the way we say vowels when different model is presented. This could explain why the subjects of this study had more success with vowel sounds in experiment three that with consonants. Another study “A Neural Basis for Auditory Feedback Control of Vocal Pitch” (Smotherman, Zhang, Metzner, 2003) points to an explanation as to why the subjects’ pitch control was noticeably improved with the “choral singing”. Again, this is an auditory-vocal phenomena.I began to question the atmosphere of the study and the other factors that may arise from unison singing with the therapist. During experiment three, did subjects watch the speech therapist they were working with? Was there an uncredited visual component to the results that was not addressed? Were the subjects lip reading or reacting to any facial expressions? Was there a subtle gesture component?Singing to a CD recording is not choral singing, and the researchers claim of “choral singing appears to be an effective means of speech therapy” is invalid and misleading. It shows how important it is to define all terms one uses in a study as clearly as possible. Choral singing then, is not an effective means of speech therapy. Rather, unison singing with one other individual or a single individual’s voice fed through a headset is. With this conclusion, browsers on the internet reading abstracts will not be so quick to jump to broad conclusions and make leaps to great implications as I first did.

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