Music Therapy Interventions for Improving Fluency Among People Who Stutter
by Erika Shira
This article by Erika Shira, is a music therapist’s overview of why music can be effective in treating people who stutter.
Shira purports that music therapy in general is an effective means of evoking neurological changes because of the way that participating in interactive music stimulates multiple areas of the brain simultaneously. The brain functions most optimally when multiple areas are working together, as areas that work particularly well can compensate for areas that work less efficiently, all the while "teaching" the less developed areas how to rework themselves to function better. When a person participates in live music, the brain must process sound, vibrations, movement, emotional states, and sequential patterns that are processed by the brain in the same way as language.
It is widely recognized that dysfluency is a multi-facetted disorder, which can include psychological, motor and auditory processing issues to name a few. A music therapist must first determine if an individual’s stutter is primarily anxiety related or if there is motor difficulty. This can be difficult as most individuals who struggle with dysfluency will likely manifest anxiety during speech.
The benefit of music therapy is that through musical expression both the primary aspects of dysfluency (anxiety and motor difficulty) can be addressed. For anxiety, musical expression can be a confidence builder. Most individuals who stutter are able to sing without dysfluency and if given a composition exercise where a story is conveyed in the first person, one gets the experience of fluent self-expression through song. For motor related difficulty, Shira compares stuttering therapies to gate therapies. In it’s simplest form, gate therapy is the rehabilitation of walking through the use of a metric beat – an even pulse that the patient would aim to walk to to rehabilitate their gate to even, regulated intervals. Music therapy takes that one step further and will play live music to the gate, accompanying the patient and matching their gate – even or not. While the individual is walking to a familiar song, Shira explains that “the rhythm of the song is processed in the temporal lobe, the order of the melody is processed in the frontal lobe and language areas, the lyrics are processed in the language areas, the personal meaning of the song is processed in the emotional areas, and so forth. With these areas all working together, the individual is very aware of when he or she is walking unevenly, as this causes the song to be played with pauses and hesitation. The brain wishes to correct the song, and the other areas of the brain work together with the motor cortex to better coordinate the person's movements.”
Treatments for stuttering work in a very similar manor, with initial sessions devoted to the singing of familiar songs to solidify that through song, fluency is possible. Songs might be sung alone or with vocal support (and family can easily be included in treatment), and eventually advance to the composition of first person story-telling and even sung, improvised dialogue. The goal is to eventually move to a more spoken style of singing, and then to remove the accompaniment and pitches resulting in normal speech based on the sung approach.
In my experience as a vocalist, I have encountered several individuals with debilitating stutters who are miraculously free from dysfluency in song. Though I understood this was a fairly broad phenomenon I have wondered if and how it might be applied through music therapy and if those therapies can lead to greater fluency in speech. Knowing that music and language both elicit complex neurological activity and also share a lot overlap in the active centres of the brain has left me suspecting that music therapies are full of potential to mitigate dysfluencies. This article does not address the research that indicates stuttering is strongly linked to auditory processing issues but I have to wonder if this too could be addressed through music therapy. Currently the auditory-based interventions for stuttering such as delayed auditory feedback don’t cure the stutter, but merely manipulate auditory feedback so the individual no longer hears themselves in real time. I have to wonder if it might be possible to train the ear using music therapy to resolve some of these processing issues. I know Tomatis considered this possibility and I will continue to look for research that looks at auditory processing therapies (not just interventions) and their effect on fluency.