Tuesday, December 6, 2011

Music Therapy Interventions for People Who Stutter


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.


mrmusic said...

This article takes me back a few years when I taught in the Toronto District School Board. It was the first time that I worked with someone who stuttered. He was the Caretaker, a colleague, who I greatly admired. Since childhood, he had stuttered and you can imagine the bullying and picking-on that he endured as a child and even as an adult, too. On the Friday before Christmas, we usually had an assembly before dismissal for the Christmas break. We sang a few carols and Christmas tunes - Must Be Santa, Rudolph, Silent Night, etc. My colleague, who was to retire at the end of the school year, told me that he had always wanted to sing "I'm dreaming of a white Christmas" as a solo. With a microphone in hand, he walked out in front of the whole school and sang, with not one stuttering consonant to be heard. The whole school stood and gave him a standing ovation. I remember not being able to see the sheet music of the carol that followed. I had experienced one of those rare 'aha' moments in life - when one witnesses, what must have been agony for years - was now a personal triumph for all to hear and enjoy!

Sarah N said...

I had a close friend a few years ago who played the cello and also had a stutter. His stutter was particularly bad, making it difficult to have any conversation with him. He had tried several things to fix it but nothing seemed to work, perhaps because a lot of his problem was rooted in self-esteem issues. But he was a fantastic cello player, and performed really well in auditions. He won several orchestra jobs before he was 25 years old. I thought watching him take all these stages by storm was so incredible. I think it gave him so much confidence in life. Even though he couldn't communicate well with his words, he could communicate fabulously through his instrument. I thought it was very poetic that even though he had this problem he also had this incredible talent that balanced it out and gave him a way to express himself and make a living.

Alicia_Ritmundi said...

I too found this article quiet interesting as a music therapist. Though I never personally worked with people who stutter, I can easily see how music therapy could benefit those who stutter.

As a student in music therapy in the US, I had the opportunity to apply music therapy as treatment in special education. The objective of the music therapy intervention was to teach basic addition problems to a student with moderate learning disabilities. With the focus being placed on the activity of music making, rather than on the mathematical content, the student was able to successfully accomplish each task.

Based on my personal experience, I could see how this approach of using music as a "distraction", could benefit someone who suffers from stuttering. By having the client to focus more on, for example singing a song and breathing, rather than placing emphasis on telling the client that he or she is not to stutter, the anxiety associated with the expectation of "failure" is lessened.

This is an area that I would be interested in further investigating.

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anna lee said...

Thank you for the blog and to share a nice information with everyone, and it's true that music can help to reduce stuttering disability. everyone like the music and like to sing the songs. so it may help to stutter.
it's really motivated blog for the stutter. help people who stutter and need to be patient, kind, understanding with them. We need to show we care too. for more help and treatment anyone can visit the site http://www.naturaltherapyforstuttering.com/

trimurthy sairam said...

Interesting write-up, thanks. In india we in NADA CENTRE FOR MUSIC THERAPY have tested some Sanskrit shlokas which sound stuttering and which helps kids coming out of their problems .

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