Singing for Parkinson’s

Many people with Parkinson’s disease (PD) have found that singing exercises may help to alleviate some of their challenges with speech and swallowing. Over 80% of people with PD experience these issues, but therapeutic approaches are limited, and may not work for everyone. Exercising the muscles used in speech and swallowing is a good strategy for self-management of these symptoms.

Voice and Swallowing

Using the same muscle groups as speech, singing provides a more controlled vocal exercise. For those who experience a soft voice, singing can improve loudness by exercising the throat, chest, mouth, and facial muscles to strengthen them, and increase mobility (Vella-Burrows et al., 2012). Other problems, like stuttering or slowed speech, can also improve with singing, as it stimulates regions of the brain responsible for articulation in speech.

Singing is a proven way to practice laryngeal and respiratory muscle control, as well as extension of the diaphragm and chest. The larynx produces sound in both speaking and singing, while the respiratory system controls the pressure used to adjust pitch and volume. Both of these muscle groups can be compromised in PD, so regular exercise is important for maintaining your abilities.

The larynx and other muscles in the throat are involved in blocking food from entering the airway during swallowing. Strengthening this muscle group through exercise can reduce the risk of choking. Strong lungs, diaphragm, and chest muscles are also important for coughing, which expels any food particles or liquids from the lungs. A weak cough may result in a buildup of bacteria in the lungs, causing pneumonia.

Many people with PD also experience a dry mouth from decreased saliva production, which can contribute to problems with swallowing, and risk of choking. Studies have shown that singing can increase saliva production, improving the oral environment (Sakano et al., 2014).

Motor Symptoms

Singing requires control of the chest and diaphragm, which are also used for postural stability. Strengthening these muscles and training your control of them can help you maintain good balance, and reduce your risk of falling. However, in addition to these direct effects of physical exercise, singing may also improve your balance and motor functioning on a neurological level.

The regions of the brain responsible for controlling movement and maintaining a steady gait also control how you process rhythm. Auditory stimulation, including rhythmic music, has been shown to help people with PD who experience freezing of gait, or problems with their walking speed, cadence, or stride length. Research suggests that by singing to produce your own auditory stimulation, you may also be better able to control your gait, and cue movement after freezing (Harrison et al., 2017).

Memory and Mood

Parkinson’s may bring changes to your sense of identity and belonging. Many find comfort in new, creative hobbies, and group activities with their peers. Parkinson’s singing groups are a valuable outlet for creativity and stress relief, where voice challenges can be met with empathy, compassion, and understanding. Participating in a shared activity with other people with PD and carepartners can be important for building relationships and community outside of the support group setting.

In a Japanese study examining the effects of group singing on seniors, the activity was found to decrease levels of cortisol, a hormone linked to stress and fear (Sakano et al.). The same study provided participants with questionnaires before and after singing, which guided them to indicate their levels of certain emotions. After singing, most people reported improvements in feelings including comfort, pleasure, light-heartedness, relief, and relaxation, and decreased levels of confusion and tension.

Socialization

Chris and Harold Olsen facilitate a singing group in Maple Ridge with members of their PD support group. The Tremble Clefs are a friendly, non-judgemental group of peers, and they welcome anyone who would like to stop in and sing a few songs with them, including carepartners, friends, and family.

As a person with PD, Chris has found great benefit from singing. “I’ve gained confidence in my ability to sing, which rolls over into other areas of my life,” she says.

The pair say the purpose of their group is three-fold: it is a fun, social outlet, a way to exercise the voices of members with PD, and a contribution to their community. The Tremble Clefs perform monthly at their local hospital.

“We have lots of fun, which brings out the lighter side of everyone, and the connections our group has made with each other have broadened into solid friendships,” says Chris.

Harold, Chris’ husband and carepartner, has a passion for music and a background in teaching, which led him to organize the group after hearing of the benefits of similar singing programs for PD. “The singing group is a way of not only having fun, but it has given [Harold] a way to keep teaching, and stay musically connected,” says Chris.

This singing group has found great success, and Chris and Harold regularly receive positive feedback from members. “We have seen confidence grow in others,” says Chris, who has noticed a commitment in every member of the group to attend practices. She sees this as “a strong indication of how important this is to them”.

Additional Resources

SongShine Program

SongShine is an effective music-based vocal program for persons whose speech has been affected by Parkinson’s disease, stroke, other neurological disorders or aging voices. The program builds voices with a holistic approach that integrates breath awareness and body alignment, vocalizes (singing exercises), singing in community, diction and articulation exercises, creative imagination, becoming a character (role playing), and emotional engagement. The program is available in communities across the province. Visit www.parkinson.bc.ca/events to view class schedules and find out how to register.

Sources

Harrison, E.C., McNeely, M.E., and Earhart, G.M. The feasibility of singing to improve gait in Parkinson’s disease. Gait & Posture, 53. 224-229. https://doi.org/10.1016/j.gaitpost.2017.02.008  

Sakano, K., Ryo, K., Tamaki, Y., Nakayama, R., Hasaka, A., Takahashi, A., Ebihara, S., Tozuka, K., and Saito, I. (2014). Possible benefits of singing to the mental and physical condition of the elderly. BioPsychoSocial Medicine, 8(11). https://doi.org/10.1186/1751-0759-8-11 

Vella-Burrows, T., and Hancox, G. (2012). Singing, Wellbeing, and Health: context, evidence and practice. Sidney De Haan Research Centre for Arts and Health. Canterbury Christ Church University, Kent, UK. https://artshealthnetwork.ca/ahnc/ngingandpeoplewithparkinsons.pdf 

This content was published in the Summer 2019 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.