Monday, November 11, 2013

The Therapeutic Effects of Singing in Neurological Disorders

Wan, C. Y., Ruber, T., Hohmann, A., & Schlaug, G. (2010). The therapeutic effects of singing in neurological disorders. Music Perception, 27(4), 287-295. doi: 10.1525/mp. 2010.27.4.287.

This article, published in Music Perception in 2010, summarizes research on the use of singing to treat various neurological disorders that can cause language and motor impairment. I am especially interested in this research because it focuses on active singing by patients, as opposed to music listening. Singing utilizes multiple areas and systems of the brain, which can help to rebuild connections and skills in patients who may have lost abilities due to neurological conditions. As the article puts it: “Unlike music listening, active music making places additional demands on the nervous system, leading to a strong coupling of perception and action; processes that are mediated by sensory, motor, and multimodal integrative regions distributed throughout the brain.” The authors point out that “[s]inging in particular can serve as a valuable therapeutic tool because it is a universal form of musical expression that is as natural as speaking.” Although some of my students may disagree with the “natural as speaking” portion of that statement, it is true that singing in one way or another is universal to almost everyone. Most people sing, even if it is only in the privacy of their own homes, whereas learning an instrument takes a certain amount of extra investment in the form of purchasing the instrument, learning the physical movements, etc. Singing at an expert level requires just as much training, but unlike, say, the violin, making recognizable music with some level of fluency is something that most people can do right away with their voices. 

All of this points to singing as a natural way for patients in recovery from a neurological disorder to participate in music making. Singing itself also has some distinct benefits that are not found with other instrument groups; it shares a network in the brain with speech, and engages an auditory-motor feedback loop in the brain. Additionally, singing has some straightforward physical benefits. One study found that singing lessons were beneficial to patients with chronic obstructive pulmonary disease. Patients who took singing lessons showed greater inspiratory capacity and higher maximum pressure on exhalation. In these patients, singing appeared to strengthen the muscles of the respiratory system.

The paper covers four neurological conditions that have been shown to respond to singing as treatment: stuttering, Parkinson’s disease, aphasia, and autism. In the case of stuttering, which is characterized by interrupted speech, repetitive sounds, and an inability to speak with fluency, the act of singing seems to help patients who stutter to smooth out their speech and speak fluidly. According to one study, singing helped to increase fluency by 90%. This may have to do with the elongation of sounds and the increased control of speech articulators (lips, tongue, etc.) that is typical of singing. Another study found that fluency-inducing tasks (such as singing) causes activation in parts of the brain related to speech processing and motor articulation. 

Parkinson’s disease is a devastating condition that manifests in a variety of ways, one of which can be a loss of control over speech. Patients may experience poor vocal quality, a decrease in speaking volume, or interrupted speech, among other symptoms. According to the article, preliminary data indicates that patients with Parkinson’s who practiced vocal warm-ups and singing exercises, as well as those who engaged in group choral singing of chants, showed improvement in vocal quality, reading, and speech intelligibility. These results were observed with small sample sizes but are encouraging nonetheless.

One fascinating use for singing therapy is with patients experiencing aphasia, or loss of speech due to stroke or other brain injury. When used as treatment for this condition, singing seems to actually rebuild or strengthen sections of the brain. As an example, the article names the arcuate fasciculus (AF), a  bundle of fibres that is involved with auditory-motor mapping and language processing. The left bundle is especially associated with language, and is larger in most healthy people; however, trained singers also show an enlargement of the right bundle. Melodic intonation therapy (MIT) has been shown to increase the right AF in patients whose left AF has been damaged by stroke. This, along with other right-hemisphere changes that can occur as a result of MIT, can cause significant improvement in the patient’s ability to process language and to speak.

Lastly, the article discussed possible applications of singing therapy for individuals with autism. As of the time of publication of this article, only two case studies had been reported; however, both indicated that singing therapy could help these individuals develop and strengthen language and communication skills. Further research is needed in this area.

As a singer myself, I cannot help but have a personal reaction to the research described in this article. Like almost any professional musician, I entered the field of music because I loved it, following a passion that seemed to defy description in its intensity. And like almost any graduate of a university or conservatory music program, I made the decision to try to become a professional musician at a young age, when I began to audition for various undergraduate programs as a teenager. At that age, the personal rewards of music-making were my motivation; it was enough that I loved it, that it satisfied me. It didn’t occur to me that I would ever want more than that intrinsic reward. 

It has now been more than ten years since I made that decision, and while I am indeed a professional musician of sorts (some combination of “young professional,” “emerging professional,” “semi-professional,” and “student”), I have found that my motivations for music-making have fluctuated over time. While it was once enough to sing in order to satisfy myself, I now frequently wrestle with the question of what music actually does in the world, and what musicians can contribute. What good can I do by possessing a highly-trained vocal instrument? Could I have offered more if I’d chosen a different vocation? In short, does music actually help anyone?

In light of this question, it’s incredibly encouraging to read about how music, and my own instrument specifically, can help people struggling with some very difficult conditions. While I firmly believe that listening to music can be a powerfully uplifting, moving, and healing activity, I am also excited to know that the act of singing seems to directly relieve suffering, at least in some individuals and under certain circumstances. This article made me eager to know more about what is involved in working with some of these patients. Clearly the therapies used have been carefully designed and would be different than simply teaching a voice lesson to a student; however, I wonder what the roles are for trained singers and voice teachers in this type of work. Whether or not there is space for singers such as myself to engage with this work in any way, I am heartened by the idea that singing can help some of these individuals develop, strengthen, or regain the ability to communicate with those they care about - which is, after all, the point of music in the first place. 

1 comment:

Cheryl Jones said...

Your reflections about the use of music for therapeutic goals and your possible contributions as a professional singer caught my attention. Your training in the vocal mechanisms, breathing exercises, and vocal diction could complement a music therapist’s work, especially in working with some forms of aphasia. You might like to consider a consultation or joint project with a music therapist at some point.

However, don’t under-estimate what you can contribute to others’ lives as a professional singer. You are able to express, with beauty, a range of emotions on behalf of others. The audience enjoys a concert, not only because of the musical quality, but also the cathartic release during the music. A song can literally “ease the burden” or provide a “quiet place” one needs in the midst of a hectic day. I could never sing out, with any passion (or beauty), what I might feel but I may listen to a singer who can do that for me.

The desire to communicate becomes especially apparent when we witness the great efforts made in speech re-hab by individuals who have experienced speech impairment as a result of a stroke or brain injury. We all need to express. As a professional singer, you can help us do that, through your songs. So, in a sense you are not only singing for yourself as you suggested in your reflections, but you are singing for all of us.