Parkinson’s disease patients have lesions on the connections between the basal ganglia and the substantia nigra. This causes a loss of dopaminergic brain cells in these pathways. Without receiving sufficient dopamine, the basal ganglia cannot adequately serve its purpose of initiating voluntary movement. Symptoms of Parkinson’s disease include a failure to combine several movement components into a single action plan, a decay of movement sequences (irregular gait), bradykinesia (slowness of movement), akinesia (lack of spontaneous movement), hypokinesia (mask-like face), rigidity, tremor when stationary, speech difficulty, and micrographia (handwriting that is shrunken in size) (Ward, 2010).
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Speech Therapy Treatments
Parkinson’s Disease has debilitating effects in the area of communication, and causes frustration for both patients and their families. The quality of life for these patients is decreased as they are more likely to withdraw from social activities due to communication impairments. For this reason, speech therapy has proven to be an effective tool in PD treatment (Haneishi, 2001).
In 1987 Raming developed the Lee Silverman Voice Treatment (LSVT) for Parkinson’s Disease with the goals of decreasing breathiness and increasing the loudness of the voice.
In 1995, Smith, Raming, Dromey, Perez, and Samandari found that LSVT also had physiological benefits, specifically when both phonatory efforts were added to respiratory efforts as a part of the treatment. The researchers thought that phonatory efforts may have the ability to lessen bradykinesia in PD patients. Raming also found that patients must be motivated to participate for the best results to occur (Smith, Raming, Dromey, Perez, and Samandari, 1995).
These studies suggested that singing may be an effective treatment for PD, as it involves great phonatory effort, and is enjoyable for patients, providing motivation.
Poor treatment outcomes and measurement techniques
In the early 1990s, Cohen conducted a series of studies involving the use of music therapy for individuals with various neurological disorders. Cohen found that those patients with progressive neurological conditions, like PD, improvements in speech were seen at a slower rate, and could not be interpreted or measured the same way as patients non-degenerative conditions. This conclusion pointed to a need for unique treatment procedures and measurement techniques for the treatment of PD’s speech problems through music therapy (Cohen, 1992).
Development of the Music Therapy Voice Protocol for PD
To address the problems incurred by Cohen, Eri Haneishi developed a methodology based on vocal instruction for patients with cerebrovascular accidents. Haneishi called this the Music Therapy Voice Protocol (MTVP) for PD. The protocol placed a large emphasis on singing exercises that use phonational and respirational effort. In his (2001) study, Haneishi used the MTVP for PD to treat and assess speech intelligibility, acoustic parameters of speech, and mood of the patients. The results showed increased vocal intensity, increased speech intelligibility, and improved mood (Haneishi, E. 2001).
First Published Study on Music Therapy in Parkinson’s Disease
Prior to the year 2000, no studies were conducted that involved the use of music therapy for the treatment of the motor and emotional problems incurred by Parkinson’s Disease. Behavioral, motor, and emotional problems were previously treated with physical therapy (PT). Pacchetti, Mancini, Aglieri, Fundaro, Martignoni, and Nappi (2000) conducted a study seeking to show music therapy’s efficacy in this area. They compared the traditional treatment method of PT with the new method of MT. Results for those in the MT group showed an increase of happiness measures, a significant decrease of bradykinesia as shown by the Unified Parkinson’s Disease Rating Scale, improvements in performing activities of daily life, and improvements in rigidity. Since music therapy had a significant effect on behavioral, affective, and motor functions for the PD patients, it the researchers proposed music therapy as a new method to be included in PD programs of rehabilitation (Pacchetti, Mancini, Aglieri, Fundaro, Martignoni, and Nappi, 2000).
Subsequent studies and music therapy practice
A study by Satoh and Kuzuhara (2008) showed that patients with Parkinson’s Disease were able to effectively utilize mental singing while walking in their daily lives. Participants received music therapy in which they walked while listening to a song. The results were significantly improved walking speed, stride length, and cadence both while walking straight and turning. Arm swinging and knee raising were also increased. After just this one music therapy session, these patients reported effectively using mental singing in their daily lives to assist with walking (Satoh & Kuzuhara, 2008).
In another stay on movement, physical function, quality of life, depression, and anxiety of individuals with Parkinson’s Disease, Clair, Lyons, and Hamburg, (2012) found music therapy to be a beneficial addition to an exercise program. The study found that those who participated in the music enhanced program showed improved perceptions of quality of life and physical functioning. These findings support the idea that auditory rhythmic cues can help to synchronize the body’s physical motor output (Clair, Lyons, & Hamburg, 2012).
De Dreu, van der Wilk, Poppe, Kwakkel, and van Wegen (2012) published a meta-analysis of music-based movement therapy (MbM therapy) in Parkinson’s Disease patients. They found that overall, MbM therapy seems to most impact gait-related activities in PD patients, as well as significantly improve the quality of life for these individuals (De Dreu, van der Will, Poppe, Kwakkel, & van Wegen, 2012).
Clair, A. A., Lyons, K. E., Hamburg, J. ( 2011), A feasibility study of the effects of music and movement of physical function, quality of life, depression, and anxiety in patients with Parkinson’s Disease. Music and Medicine, 4 (1), 49-55.
Cohen, N. S. (1992). The effect of singing instruction on the speech production of neurologically impaired persons. Journal of Music Therapy, 29, 87-102.
DeDreu, M. J., Van der Wilk, A. S., Kwakkel, G., & Van Wegen, E. E. (2012). Rehabilitation, exercise therapy and music in patients with Parkinson’s Disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. Parkinsonian and Related Disorders, 18(1), S114-S119.
Haneishi, E. (2001). Effects of a Music Therapy Voice Protocol on speech intelligibility, vocal acoustic measures, and mood of individuals with Parkinson’s Disease. Journal of Music Therapy, 38(4), 273-290.
Pacchetti, C., Mancini, F., Aglieri, R., Fundaro, C., Martignoni, E., & Nappi, G. (2000). Active Music Therapy in Parkinson’s Disease: An integrative method for motor and emotional rehabilitation. Psychosomatic Medicine, 62, 386-393.
Satoh, M., & Kuzuhara, S. (2008). Training in mental singing while walking improves gait disturbance in parkinson’s disease patients.European Neurology, 60, 237-243.
Smith, M. F., Raming, L. O., Dromey, C., Perez, K. S., & Samandari, R. (1995). Intensive voice treatment in Parkinson’s disease: Laryngostroboscopic findings. Journal of Voice, 9(4), 453-459.
Ward, J. (2010). The students guide to cognitive neuroscience. (2 ed., pp. 173-176). New York: Psychology Press.
By: Claire Growney