Rhythmic Rehabilitation: The relationship between music and dysarthria management

Published: November 30th, 2017

Category: UAD Student Blog

By Ariana Rose and Brittany Schmidt

The act of singing, often trivialized as a recreational activity, is beginning to show
potential in the therapy realm. While music therapy has been popularized in many
respects for its psychologically therapeutic purposes, there is increasing evidence
indicating that its rhythmic quality could also benefit patients physiologically. Speech Language
Pathologists have begun to investigate the impact that incorporating music in
therapy protocol could have on progress in patients referred for mild to moderate
dysarthria. Some therapists have even witnessed improvements in their own patients
when treatments featured some form of musicality.

Dysarthria refers to a group of speech disorders, neurologic in nature, that
manifest as varying forms of abnormality in respiratory, phonatory, articulatory, and
prosodic components of speech production. These abnormalities are the direct result of
impairments in the “strength, speed, range, steadiness, tone or accuracy” of related
movements. These neuropathophysiological disturbances can be attributed to varying
types of atypical sensorimotor functioning, such as incoordination, spasticity,
hypertonicity, hypotonicity, weakness, or involuntary movement (Duffy,2013). Dysarthria
can vary greatly in its severity of presentation, but in all cases, this neurologic
movement disorder impairs the communicative ability of the patients with the diagnosis.
Some common therapy protocols for dysarthria takes a combined approach featuring the Lee
Silverman Voice Treatment program, articulator strengthening exercises, and speech
endurance tasks. The Lee Silverman Voice Treatment (LSVT) program, focuses on the
goal of loud speech to “improve respiratory, laryngeal and articulatory function to
maximize speech intelligibility.” But what happens when standardized protocol doesn’t
quite meet patient needs?

When Speech-Language Pathologist Betty McMicken first met critically
acclaimed actor Kirk Douglas, she was unsure of her ability to help him. Many
Americans remember Douglas from his roles in 1940s films, such as Champion and The
Great Sinner, but few are aware that the esteemed actor suffered a stroke in 1996.
Since then, Douglas has been managing moderate dysarthria symptoms over many
years of speech and language therapy. Although Douglas had made little progress
through therapy, he was confident sessions with McMicken would be different. After
consulting with colleagues, McMicken decided to incorporate familiar lyrics into standard
LSVT protocol. She believed that the “meter, breath phrasing, and multisyllabic difficulty
within the pentameter verses” would assist Douglas in monitoring his rate, phonation,
resonance, and articulation. For Douglas, therapy gains eventually resulted in his
renewed ability to maintain performance level speech, allowing him to return to the
stage for a series of solo shows.

Similar anecdotal evidence has been witnessed by many SLPs, and there is
emerging scientific support for rhythmic focus in speech therapy. For dysarthric patients
who have seen it all, but seen little progress, rhythm may be the answer.

References

Duffy, J. (2013). Spastic Dysarthria. (3rd ed.), Motor speech disorders: Substrates, differential
diagnosis, and management (pp.128). St. Louis, MO: Elsevier.

Sharkawi, A E. “Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT(R)):
a pilot study.” Journal of Neurology, Neurosurgery & Psychiatry, vol. 72, no. 1, Jan.
2002, pp. 31–36., doi:10.1136/jnnp.72.1.31.

“Tip Top Timbre.” ASHA Leader, vol. 18, no. 3, Jan. 2013, p. 42.,
doi:10.1044/leader.ftr1.18032013.42.

“What is LSVT LOUD?” LSVT Global – What is LSVT LOUD?,
www.lsvtglobal.com/patient-resources/what-is-lsvt-loud.