The symptoms of Parkinson’s include tremor, particularly in the hands, arms, legs, face and jaw. It causes a slowness in movement, problems with balance and emotional changes.
These symptoms are often the prime focus of research, but they are not the only life-changing difficulties that Parkinson’s disease presents.
Impairments in breathing and voice are also substantial hurdles that cause a significant drop in quality of life.
Voice impairments impact 60-80% of Parkinson’s patients. Their voice can become monotone and display less variety in volume; there may also be a reduced vocal intensity and pitch, and a harsh, breathy voice.
Standard Parkinson’s treatments do not target these aspects with the same level of success as the motor symptoms. Deep brain stimulation of the subthalamic nucleus, which relieves many of Parkinson’s classic symptoms, can, in fact, make voice alterations worse.
Parkinson’s voice therapies
Although there are various interventions designed to improve voice and breathing deficits, they do not tend to address overall quality of life, and, as symptoms progress, drop out rates of these therapies are often high. This means that even the most beneficial therapies do not always have the opportunity to take full effect.
Researchers at Iowa State University, led by Elizabeth Stegemöller, set out to investigate whether group singing could help relieve some of the voice symptoms of Parkinson’s disease and, at the same time, increase quality of life and whole health measures.
Singing is a culturally universal pastime that improves bonding and produces a sense of belonging that traditional therapies often cannot match. Additionally, singing can be considered an elongated type of speech with particular emphasis on rhythm, tempo, tonal changes and respiratory control.
Parkinson’s therapy involving singing has been trialed in previous studies, but findings have been mixed. This study is the first to test whether improvements in symptoms can be affected by “dosage,” in other words, can two singing sessions a week be more effective than one?
Can singing relieve the symptoms?
The trial consisted of 27 Parkinson’s patients who attended group singing sessions either once or twice a week. Before and after the 8-week trial, swallowing measures and voice measures, such as the patient’s vocal range and how long they could hold a note, were recorded.
Therapy sessions involved vocal exercises, followed by renditions of popular songs, including “You Are My Sunshine” and “Show Me The Way To Go Home.”
The researchers found that, after 2 months of singing, there were significant improvements in pitch duration, vocal loudness and swallow control.
Both groups (one session per week and twice per week) demonstrated a significant improvement in maximum inspiratory and expiratory pressure, as well as phonation time. Other voice measures improved, but not to a statistically significant degree.
Importantly, questionnaires that assessed the impact of voice changes on their quality of life (and their overall quality of life) showed significant improvements. Interestingly, there were no differences between the two groups; both benefited equally.
“With people who have Parkinson’s disease, what you’re hoping for is maintaining these skills – because it’s a progressive disease. If we can improve the voice, then maybe there’s hope to maintain that function a little bit longer.”
‘Singing addresses social and emotional aspects’
This research was just a pilot, and the team plans to expand the investigation once funding has been secured. Medical News Today asked Stegemöller about the type of study she would conduct in a perfect world; her aim is to produce a large-scale project measuring more parameters, including “voice, swallow, respiratory, quality of life, social network, depression and anxiety.” She continues:
“I would also like to examine the associated brain changes. Finally, I would like to develop methods to bring this music therapy-led intervention to as many persons with Parkinson’s disease as possible.”
Stegemöller has a passion for music, how the brain responds to it and its use in therapy. It is a fascinating topic that spans scientific fields as diverse as human evolution, sociology, psychology,endocrinology and neuroscience. MNT asked Stegemöller how she thinks singing might have evolved in human culture, and she said:
“I believe that music evolved as an initial method of communication before formal language was developed.”
It seems oddly satisfying that a primal social activity like singing might be used to treat such an intractable disorder that modern medical science is still battling against. Stegemöller says “something like singing is not only addressing the physical needs but also the social and emotional aspect.”