Tuesday, November 12, 2013

Singing effects in Neurological Disorders

Reference: 
The Therapeutic effects of Singing in Neurological Disorders
CATHERINE Y. WAN, THEODOR RÜBER, ANJA HOHMANN, AND GOTTFRIED SCHLAUG Beth Israel Deaconess Medical Center and Harvard Medical School (2010)
Music Perception: An Interdisciplinary Journal, Vol. 27, No. 4 (April 2010), pp. 287-295

Review:
 This article reviews recent evidence on the therapeutic effects of singing in reference to speech problems, Parkinson’s disease, brain lesions, and autism. Singing as a therapeutic approach to treat neurological disorders is not a new idea, but one that is growing in recognition given the similarities between singing and speech, and the neural correlates of both (287).

Active music making, including singing or playing an instrument, obviously creates different demands on our neurological pathways than the act of listening to music. These additional demands on the nervous system lead to a strong pairing of perception and action, connecting a musical action to the sensory and motor parts of the brain. In this article, the authors show a figure of the difference in size between the right-hemisphere fiber tract (connecting auditory with motor regions of the brain) of a professional singer and a participant who sings only occasionally. In the diagram it is clear to see the difference in size between the two. Unlike other forms of music making, singing is a particularly valuable therapeutic tool not only because of its connections to speech, but also it engages this auditory-motor feedback exercise in the brain more readily (288).

The first neurological based disorder looked at in this article is stuttering. The authors of this article review several studies that have been done in the past thirty years on the therapeutic use of singing and stuttering, specifically how the use of familiar songs can help in speech flow of the individuals. In 2003, a neuroimaging study was done on the these effects, and it was found that the areas of the brain that were active in fluent speech (singing) and in dysfluent speech (reading unknown sentence) were the same areas of the brain involved in both motor/pre-motor regions as well as the sensory/auditory areas. This study showed that the act of singing (or fluent action of sound/speech) produced more activity in the left hemisphere of the brain, suggesting that this can help create fluency (289).

Further, this article reviews the effect of singing on both Parkinson’s disease and Aphasia, coming to similar conclusions. In Parkinson’s Disease, 80% of individuals diagnosed develop some sort of speech problem including: breathiness, lower volumes of speech, and short phonation time (290). The LSVT (Lee Silverman Voice Treatment), is a treatment that already exists to help reduce some of the problems associated with Parkinson’s Disease. Others have used singing and singing exercises specifically as a way to improve phonation and breath abilities of these patients, and have seen the long term effects of this work. In relation to Aphasia, much more has to do with the locations in the brain of injury. Fluent aphasia results generally from a lesion involving the posterior superior temporal lobe (Wernicke’s area). These individuals generally have severe speech comprehension problems (290). In contrast, nonfluent aphasia mainly affects the left frontal lobe and left posterior inferior frontal region (Broca’s area). These individuals generally have good speech comprehension skills, but have problems when it comes to speech production.

In the diagram of the brain, the authors show that through singing training and specifically melodic intonation therapy (MIT), that the fiber tract connecting the auditory and motor regions of the brain can strengthen.

Through these studies, the authors illustrate the ways in which singing is not only simply therapeutic, but helpful in neurological processes. In the physical manifestation of speech problems, singing helps with the connectedness of words and syllabic delivery. Secondly, singing engages a “larger bihemispheric network” (297) than simply speaking, which primarily engages the left hemisphere, helping create a use of other working area of the brain. Singing can help with the idea of sound-motor mapping, and this is particular helpful to these disorders that are connected to an articulartory-motor component.

At the end of the article, the authors clearly state “Taken together, there appears to be a number of possible mechanisms underlying the efficacy of singing in ameliorating the symptoms of various neurological conditions” (291).

Reflections:
What I found so interesting about this article was that I always thought of music and singing as therapeutic, but to think of singing as a specific tool to help develop and grow connecting pathways in the brain was so interesting to me. 

While I was doing my undergraduate degree, I worked part-time with several kids with developmental disabilities. Several of the clients I worked with had severe cases of autism, and I could see the effects of music on them. Of course, each individual is so different, but I worked primarily with one boy (about 10yrs old) who had a very limited vocabulary (maybe 30-40 words), but seemed to have a generally high level of comprehension. Whenever we would sing familiar songs with him, he would often input some words in the song that he would generally never use in speech, even when prompted. This idea of singing being something that can help create avenues for speech is quite interesting to me. The diagram in the article (which I tried to post in this blog, but it wouldn’t copy correctly), is what made it very real to me that there is physical healing in singing, not simply an emotional release, or just all ‘fun’, but legitimate healing and growth of brain (and therefore body) abilities and functions. In a way, this gives me a new appreciation for singing, and the holistic healing that it can give.

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