Thursday, November 24, 2011

A Summary- Language and speech: Distinguishing between aphasia, apraxia, and dysarthria in music therapy research and practice

King, B. (2007). Language and speech: Distinguishing between aphasia, apraxia, and dysarthria in music therapy research and practice. Music Therapy Perspectives, 25(1), 13-18. Retrieved from http://ezproxy.qa.proquest.com/docview/199553722?accountid=14771

Summary

Betsey King, o f Nazareth College, writes of the effectiveness of music therapy in the treatment of communication disorders in her 2007 publication, Language and speech: Distinguishing between aphasia, apraxia, and dysarthria in music therapy research and practice.

King states that music therapists can be effective in the treatment of communication disorders, however; it is critical that the distinction between language and speech is understood in order to evaluate the effectiveness of music therapy. The following example has been used to better clarify the aforementioned statement, “Clients who demonstrate increased intelligibility through singing may not have an understanding of the words they are producing, while other clients may have ideas they are unable to express” (King, 2007). King suggests that the problem exists with the definitions used for speech and language disorders; the literature in speech-language pathology is not consistent in terminology. She adds that for music therapists, the lack of a comprehensive model which integrates current knowledge of the neuroscience of speech and language, and an understanding the process of communication, with the music therapy strategies can have an impact on these areas.

Principles of Verbal Communication
The American Speech-Language Association has defined speech and language as a “language code made up of rules that include what words mean, how to make words, how to put them together, and what word combinations are best for what situations. Speech is an oral form of language” (ASHA, 2004).

King reports that the act of communication is a complicated process, from the conceptualization of an idea and the production and articulation of speech sounds by one person to the reception of those sounds and comprehension of their meaning by another. King quotes, Dronkers and Ogar (2004), “Thought must be translated into linguistic representations (itself not a trivial feat), which are sent to speech mechanisms that can coordinate, initiate, modify and execute the articulation of an utterance”.

King notes in this publication, how researchers and writers have described the process of verbal communication in both neurological and conceptual terms.

Neuroanatomy of Speech and Language
Multiple parts of the brain are involved in this process of speech and language. King reinforces the writings of various researchers who emphasize the need to acknowledge the numerous brain areas involved in speech production. Music therapists understand the evolution of how music is processed in the brain, therefore; “it may be argued that the perception, encoding, and reproduction of musical sounds requires neural mechanisms that are at least as complex as those for speech” (Zatorre, 2001). King recommends music therapists who are interested in this subject, not only familiarize themselves with the neurological structures and connections involved in verbal communication, but also with the areas of the brain related to communication. Not only will this help in understanding any articles or texts with the aim of discussing speech and language, says King, but it will also help music therapists facilitate cooperation and learning between themselves and speech-language pathologists (King, 2007).

Aphasia, Apraxia, and Dysarthria
“Aphasia is a language disorder. Apraxia is a disruption in motor planning. Dysarthria is a neuromuscular impairment that causes weakness or rigidity of movement” (King, 2007). It is critical that the distinctions between these disorders be comprehended in speech-language therapy but also importantly, be understood in music therapy. The following example was given in regards to speech disorder: “One client may be able to sing without understanding the significance of the lyrics; another may recognize the song but may not have the motor planning to produce the words of the song; and another may sing with clearly understanding the meaning of the words but not possessing clear articulation” (King, 2007).

King also refers to the three components of language: cognition, linguistics, and pragmatics. These are separate from the motor and muscle issues that can affect speech. Cognition refers to our interpretation and understanding of the world and how we store and access that information (King, 2007). This area of linguistics includes the meaning and form of language; terms used in linguistics include semantics and syntax. Pragmatics refers to how we use language in social settings. Music therapy can greatly impact these three areas by supporting memory and retrieval of information (Foster and Valentine, 2001), by reinforcing the sequencing of words and concepts through repetition, writes King (Kumin, 2003), and by utilizing various musical forms, as an example, call-response, to promote social interaction (Clair, Bernstein, and Johnson, 1995).

Aphasia is a disorder of language that results in “convoluted syntax and meaning” (King, 2007; LaPointe, 1997, p.22) and affects cognition, linguistics, and pragmatics. King lists several types of adult-onset aphasia, some which result in impaired speech output (nonfluent) and some which do not (fluent). Broca’s aphasia is characterized by “nonfluent, halting verbal output” with shortened phrases, incomplete sentences, and disturbances in prosody, the rhythm, and intonation of speech (Kearns, 1997).

Apraxia of speech (AOS) is a neurologic deficit that impairs motor planning and, thus one’s ability to “program, position, and sequentially move muscles for the volitional production of speech” (King, 2007; Hedge, 1997; Wertz, LaPointe, Rosenbek, 1984). Adult-onset apraxia often occurs in conjunction with Broca’s aphasia but is a distinct disorder that requires different interventions than those for aphasia (Kerns, 1997).

Dysarthria is characterized by weakness, in-coordination, or paralysis of the muscles necessary for speech (Hedge, 1997). While apraxia is a disorder of motor planning, dysarthria is a disorder of motor activation.

Another way of looking at speech and language dysfunctions is to examine the difference between propositional and automatic communication. Propositional speech is created and produced for a specific situation. In contrast, automatic utterances consist of well-rehearsed sequences and emotional speech such as profanity.

King recommends that music therapist be aware of these types of speech as they could easily be viewed as signs of speech recovery during singing; more than likely, the client is exhibiting automatic speech, rather than volitionally producing words to communicate specific information.

Music Therapy and Language
The research base in music therapy is not very substantive in providing clinicians with the effective treatments for communication disorders.

When examining the majority of the songs familiar to music therapy clients revealed that the lyrics seldom represented a concrete, functional concept; instead, metaphor and imagery were dominate factors which the clients related (Bortons and Koger, 2000). This means, according to King, that a client who has developed aphasia cannot use songs to recover the meaning of words.

A more recent development in the treatment of speech disorders through music is Rhythmic Speech Cuing, a technique developed at Colorado State University and based in neurological response to rhythm (Thaut, McIntosh, & Hoemberg, 2001; Cohen, 1998). This research demonstrates the ability of rhythm to significantly impact on motor skills, including those involved in speech.

Michael Thaut (Unkefer & Thaut, 2002), suggests 5 steps for music therapist to evaluate, how effective music is on stimulus: 1) reviewing theory, 2) surveying knowledge about neurological processing of music, 3) determining the relevance of particular responses to music therapy goals 4) creating a model of stimulus processing and clinical applications, and 5) illustrating the model through clinical examples.

Music therapists, as suggested by King in her closing statement, “should increase their knowledge and awareness of the distinctions between language and speech and modify [their evaluation] interventions accordingly” (King, 2007).

Reflection
As a music therapist who fully supports the on-going research of music therapy in neurological settings to enhance practice, I found the contents of this article applicable to my own professional life in the field of music and health.

“Examining the majority of songs familiar to music therapy clients reveals that the lyrics seldom represent concrete, functional concepts; instead, metaphor and imagery predominate. This means that a client who has developed aphasia cannot use songs to recover the meaning of words. For example, a client with aphasia may be able to sing, “ If I Had a Hammer” or “Yes, I Have No Bananas, “ but may not make any connection between those words and the tool or the fruit. Further, neither of those songs, nor most others that are well known to our older clients, contain references to the concepts those clients might need to express, such as rest, the presence of pain, or the need to use the bathroom.

The previous quote exemplifies, in my opinion, the practice of numerous music therapists who lack familiarity and knowledge of substantive treatments in the field of neurological music therapy. As stated above, many activities utilized in music therapy have not been designed to be diagnosis specific, meaning they have low therapeutic value, as the content of the treatment has not been thoroughly assessed for the benefits.

Furthermore, I believe that an injustice is rendered to the practice of music therapy, when the practitioners themselves fail to present a comprehensive knowledge of the current research in the field. Without sound research in the area, neurological music therapy fails to gain validity among contemporaries.

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