HEREFORDSHIRE PCT

2006-2008

Group Singing as a form of Speech Therapy for People with Parkinson’s.

Abstract.

The purpose of this study was to investigate whether group singing lessons provided by

a professional singing teacher, could provide an effective means of improving and

maintaining voice dynamics for people with Parkinson’s.

The study was undertaken by recruiting people with a diagnosis of Parkinson’s with

voice problems and inviting them to attend a two hour singing session every fortnight

for two years. An assessment of voice dynamics using the Frenchay Dysarthria test was

carried out by the local NHS Speech and Language Therapist at the beginning of the

study then every six months for two years.

It was expected that singing would provide benefit to all four main parameters of

speech: respiration, phonation, movement of facial musculature and articulation.

It was also possible that the group sessions would provide support and an element of fun

and thereby improve quality of life. This was measured using the validated PDQ39

measure of quality of life for people with Parkinson’s.

There were small but statistically significant improvements in the laryngeal elements of

the Frenchay Dysarthria Score over the two years. These results warrant the further

investigation of a more rigorous research project.

Research team:

Mr. M. Canavan: person with PD who originally thought of the idea and has been the

work force behind the project.

Mrs. Caroline Evans Parkinson’s Nurse Specialist. (PDNS) Hereford PC

Mr. R. Langford. Singing Teacher with an interest in Parkinson’s.

Mrs. R. Proctor . Speech and Language Therapist for Hereford PCT.

Other Contributors

Miss .A .Dunlop: Librarian Hereford Post Graduate Library.

Mr. B .Foster : Organizational support and partner of one of the participants

Mr. C .Foy : Medical Statistian, Gloucestershire R&D Support Unit

Mrs. T .Knott: Data input

Mrs. T. Meredith :Speech and Language Therapist for Hereford PCT

Mr. T. Ruth .:Person with Parkinson’s involved in providing I.T support to the session.

BACKGROUND

Parkinson’s is a chronic, progressive neurodegenerative disease for which there is no known

cure. As yet no treatments have been demonstrated conclusively to alter the natural course of

the disease. The aim of therapy is therefore to minimize the substantial burden of Parkinson’s

on individuals, their families, medical and related services. (Miller 2002)

Parkinson’s can severely affect a person’s ability to communicate. Earlier studies suggested

a round 50% of people diagnosed with this condition will present with communication

difficulties that increase as the disease progresses (Scott and Caird 1983). More recent figures

suggest this may be closer to 80% (Miller et al 2006) with the PDS quoting 75-89% of people

with PD experiencing a reduced ability to communicate (Jones 2007).

Much has been written about communication problems in Parkinson’s disease; speech can

become soft and monotonous and lack fluency. Holmes( 2000 ) described a range of voice

problems associated with Parkinson’s including limited pitch, loudness variability,

breathiness and harshness and others have also described monotony of pitch, reduced stress,

variable rates, imprecise consonants and hypo kinetic dysarthria (Wohlert 2004 Pinto et al

2004, Ozsancak et al 2006)

A systematic review of Paramedical Therapies for Parkinson’s Disease carried out by Deane

et al (2002) included Speech Therapy and indicated that there has been insufficient

randomized controlled trials to determine the effectiveness of therapy. The literature search

reflected this but here have been some interesting studies which identify people with

Parkinson’s may have clearer voices when singing or reading (Kempler2002).

In work carried out by Speech Therapists during the 1980’s (Scott and Caird 1983) it was

demonstrated that intensive domiciliary therapy maintained for three months produced

favourable benefits for voice dynamics. Further work in 1990 examined the more

conventional approach of twice weekly clinical intervention in a hospital setting. (Johnson

and Pring 1990). Again demonstrable benefits were noted.

Much has been written about the Lee Silverman Voice Treatment LST. (Olson et al 1995,

Baumgartner et al 2001,Liotti et al 2003)This is an effective therapy but is given on an

individual basis and consists of 16 intensive sessions given by a therapist who has completed

the LST training. In cannot be emphasized enough the importance of trying to improve the

level of evidence of effectiveness of therapy provided by NHS. As Pickstone (2007) suggests,

Commissioners are asking what is the value of Speech therapy and what evidence we have

that it actually works, and therapists should be involved in the research field.

In Herefordshire the availability of ongoing Speech Therapy for chronic, progressive

neurological conditions is limited by resources.

Hereford Speech Therapy Service for adults consists of one full time equivalent therapist for

the whole county. There is no specialist neurological Speech Therapist.

Referrals to the department for people with Parkinson’s (PWP) are put on to a waiting list

which often runs at six months.

PWP are assessed as individuals in the following manner:

· The Frenchay Dysarthria Test, which measures pace, articulation, projection,

volume, breathe control and swallowing.

· The Therapist also looks at hypo and hyper nasality.

· A programme of exercises is then put together for any aspects that are causing

problems.

· The patient is also given a written dysarthria advice sheet.

· The therapist will also suggest strategies for improving conversation for people

who have festination of speech. These include the use of pacing boards and cue

cards.

· All patients are given 6-8 individual sessions of 45 minutes then discharged with

the ability to self-refer back later if needed.

This method fails to cover all of the problems that are common in Parkinson’s such as loss of

volume or problems with the palette. (Morris et al 2003)

Home exercise programmes require motivation which, along with depression, is a

recognizable problem in PD (Gillam 2006). Parkinson’s is a progressive condition and

therefore therapy needs to be ongoing.

The four main parameters or speech, namely respiration, phonation, movement of facial

musculature and articulation may all be affected by Parkinson’s and it was thought that the

work needed to improve the singing voice, may translate well into a fun session for people

with PD whilst possibly improving their voice dynamics.

A search of the literature showed that although singing has been used as a means of

improving quality of life for a variety of neurological conditions,(Magennis 2004, Baker

2004,Magee 2004, Carroll2000), only one study has been found where group singing was

specifically used for people with Parkinson’s(Pacchetti et al 2000). It was part of a study to

explore the efficacy of active music therapy on motor and emotional functions in people with

PD.

The participants were offered session of choral singing, voice exercises, rhythmic body

movements and music therapy using instruments. Although improvements in motor function

were found, there was no specific mention of effect on voice dynamics. There was however

improvement on emotional function throughout the study period but this did not last after the

study was completed suggesting a possible link between mood and socialization. Another

small study (four participants) looked at individual music therapy including singing sessions

for people with PD. This small study showed statistically significant improvement on speech

intelligibility. (Haneishi 2001).

The studies which looked at music therapy to help people with neurological communication

problems identified the similarity between speech therapy and music therapy (Hobson 2006).

In this study looking at collaboration between Music Therapists and Speech Therapists

Hobson describes how “music shares particular structural characteristics with speech, yet

music may be processed somewhat differently using both hemispheres of the brain”. This

therefore makes the use of music as therapy a holistic brain phenomenon. Hobson goes on to

describe how singing is relevant in speech therapy because both singing and speech entail

natural expression, frequency, range, rhythm, intensity and diction. The findings of a small

study by Baker et al (2005) found that in the long term, song singing can improve vocal range

and mood and enhance the affective intonation styles of people with traumatic brain injury.

Another interesting study looked at the influence of singing by caregivers for people with

dementia (Gotell et al 2003).Both background music playing and caregiver singing had

strong influences on posture and sensory awareness.

More recently, delegates at a European Parkinson’s disease Association conference heard

how music and dance can “contribute to a transformation” in people with Parkinson’s.

(Graham 2007). Dr Montanari told the conference that music can help people’s

communication skills and provokes emotion, imagery and memories, and finished by quoting

Plato: “Music flatters the senses and calms the soul”.

Communication difficulties can clearly have an impact on quality of life. Miller et al 2006)

identified four impact themes:

I. interaction with others,

II. problems with conversation,

III. feelings about intelligibility,

IV. voice.

These were found to affect self concept, participation inside and outside of the family and

family dynamics.

This is put into perspective by Robertson (2006) in her response to Millar’s study; She

describes people with PD being “Relegated to a listening role by their hesitant, hypo phonic

speech”.

It has been recognized that music can improve mood, and social interaction can improve

quality of life (Schroder 2006, Haneishi 2001, Pachetti et al 2000).

Rationale

The possibility of using singing as a form of therapy was suggested by a person with

Parkinson’s who had been a tutor in the Expert Patient Programme. Further encouraged by

the governments support for direct involvement of patients and public (PPI) two taster

sessions were tried using a professional Singing Teacher working with a local Speech

Therapist. These were initially run as part of a social support group.

There is a growing recognition in health care of the expertise patients bring to the

management of their own illness or condition(Cavannagh et al 2007) and one of the

highlights of this research project has been the guidance and considerable work carried out by

the people living with Parkinson’s.

Because of the impact of communication problems on quality of life it was decided that

alongside voice measurements, the participants would also be asked to complete a quality of

life questionnaire.

AIMS AND OBJECTIVES

Aim

To ascertain if singing in groups can effectively improve the management of voice dynamics

for people with Parkinson’s.

Objectives

Assess the voice dynamics of a group of volunteers who have speech problems due to

Parkinson’s.

· Provide a series of singing sessions.

· Measure any changes in voice dynamics following the singing sessions.

· Provide feedback to the volunteers.

· Use the information to inform the wider community, particularly those with PD and

those involved in their therapy.

DESIGN AND METHODOLOGY

Participants

A sample of 20 volunteers were required to provide adequate data but the group sessions

were also open to people who wanted to join in the singing but did not wish to be part of the

study.

The sample was taken from the case load of the Hereford PCT Parkinson’s Disease Specialist

Nurse. Initially an invitation was sent to the whole case load to attend a taster session. At this

session the purpose and details of the study were given and written information given to those

who were interested in taking part.

This information was taken away and a two week time lag given to respond.

Ethical considerations

There were no significant ethical considerations other than:

· The inconvenience of travelling to site.

· The possibility that it will not have any significant benefit.

The potential benefit included:

· Improved voice dynamics which may help improve socialization.

· Improved sense of well being

· Sense of achievement.

· Group Support.

The volunteers were then invited to a voice assessment session prior to commencement of the

project.

Inclusion criteria:

· Medical diagnosis of Parkinsonism.

· Literate in English language to enable reading of song words on screen.

· Able to mobilize independently or have a willing carer to attend sessions.

Exclusion criteria:

· Anybody requiring physical attention or help for mobility or personal care during

the session as at most sessions only the Singing teacher would be present other than

participants.

Although 20 people volunteered to join the study only 17 of these actually participated for

the first voice measurements.

The final sample was therefore of 17 people with Parkinson’s aged between 48 and 81 years

(average age 67 ) of which 11 were men and 6 were female.

They were at varying stages of Parkinson’s with an average length since diagnosis of

9 years (2-20).

Interventions

A professional singing teacher was found by approaching the local Council Music Pool who

provide music schemes around the county. The singing teacher had a personal interest and

understanding of PD as his late mother had a diagnosis Parkinson’s.

Singing Teacher Approach.

Once the teacher had been approached by the research team he took the opportunity to

research the approaches required for people with Parkinson’s. Following discussion with the

Speech Therapist he looked at the Lee Silverman technique which describes six areas of

concern in the voices of people with PD.

1. Sustaining the voice

2. Increasing and varying volume.

3. Varying pitch and expression

4. Quality of diction.

5. Controlling vocal speed.

6. Increasing fluidity of diction.

The teacher designed a programme based on a Phonation Pyramid.

CONTROL

CLEAR DICTION

VIBRANT SOUND

GOOD BREATHING

POSITIVE POSTURE

Positive Posture

The session starts with physical exercise to get a good posture which allows mechanics of the

voice to be free. This includes;

· Alignment of the spine, ribs, neck and jaw.

· In a sitting position the participants relax and flop then become erect but relaxed,

ensuring feet legs and knees and aligned.

· Swimming strokes with the arms.

Standing using the technique of imagining head attached to the ceiling by a rope.

· Then a “welcome step this way” gesture which use voice and movement and gets

the participants laughing and relaxed.

· Some neck and face exercises complete this stage of the session.

Good Breathing

This follows the technique used by speech therapists.

Using the analogy of a fluid breath the class runs through a series of breathing exercises:

· *Unvoiced sigh*voiced sigh*energised voice sigh.

· Vocal trampoline-ing

· Energized vocal consonants

· Breathing in time, i.e. counting 1 in -4 out, then 1 in -six out etc up to 1 in- 12 out.

· Phonation: increasing and decreasing volume (avoiding changing pitch) using

consonants.

Vibrant Sound

· Sirening : taking voice up and down pitch

· Lip and tongue trill -using energized breath

· Mironing: lift tongue to roof of mouth.

Then vocal exercises: i.e. Call and response to well known tunes to get the group into singing

mode. Firstly the teacher does the calling and the group responds, then they split into couples

and take it in turns to call and respond.

Laughing during this exercise helps relax the diaphragm!

The original six goals are then utilized by giving phrases to sing and ask the group to use

some of the goals i.e. varying pitch, controlling vocal speed etc.

Clear diction.

Singing a song removing the consonants so “Feel fine feel good” would be “ ee –i-ee-oo”

This helps hypo nasality.

Then remove vowels so “feel fine feel good” becomes fl-fn-fl-gd”.

The group then starts singing whole songs. Generally the teacher uses songs that are well

known, but he chooses songs which have elements which can address some of the six goals.

So “High on a Hill stood a Lonely Goatherd” ranges a whole octave so can help with varying

pitch.

Vocal Speed can be affected by the speed of the song.

Over the two years of the project the teacher has noticed the following developments within

the group:

· Much more vocally competent when socialising at welcoming and tea-break.

· Can make a much clearer sound as a group.

· Enabled to address dynamics and complicated speech patterns which they were

unable to do originally.

· Evident sense of well being

· Can now concentrate on the quality of the singing.

Measurements

Every six months the participants were reassessed using the Frenchay Dysarthria Assessment

tool.(annex one)

Finding an effective method of evaluation proved difficult. As described by Webb et al (

2004 ) although perceptual evaluation scales for dysphonia are regularly used, their reliability

has been poorly demonstrated.

The Frenchay Dysarthria Test has been designed to be short and easy to administer, is

sensitive to change in speech and requires little training to administer reliably and presents

results that are easy to communicate to others. It requires patients to do a few simple oral and

respiratory movements to identify areas that are affected. It measures pace, articulation,

projection, volume, breath control and swallowing. (Enderby 1988).

It was decided to use this method of assessment as it was already in regular use by local

speech therapists and therefore did not require additional funding or training. This was an

important aspect for a small pilot project.

The two Speech Therapists undertaking the assessments, remained constant throughout the

study with participants allocated the same therapist for each assessment.

Participants were also asked to complete the PDQ39 Quality of Life Tool (annex two) before

the study and every six months for the two year duration of the study. This tool is a tick box

questionnaire which allows for people with difficulty handwriting. The PDQ39 was chosen as

the measurement tool as it has been well validated (Haapaniemi et al 2000, Jenkinson

1995,Peto et al 1995 and 2001,Gaudet 2002 ). Indeed Marinus et al (2002 ) carried out a

systematic review of disease specific measurement tools and concluded that for most

situations the PDQ39 would be the most appropriate tool to use.

Resources and Cost

A suitable venue was found by the patient team member and he remained responsible for the

booking of the hall throughout the study. It needed to be easily accessible and central for a

large rural county.

The Speech Therapy input for assessments could be justifiably carried out within current

workload as all of the participants should on the waiting list or current active list for Speech

Therapy. However to carry out adequate assessment takes 30 minutes per patient, therefore

assessment of 20 people will take ten hours or two days worth of SaLT time. Approximate

cost at £250 and this was needed at the beginning of the course then every six months i.e.

£250 x5= £1250

The Singing Teacher was paid at approximately £35 per hour= £70 per session 22 sessions

per year total cost for the study = £3080.

Equipment had to be purchased to allow projection of words and music (people with tremor

and bradykinesia find it difficult to handle pages of words and music.)

Laptop £500

Projector £500

Screen. £100

Singing teacher provided the keyboard.

Postage for initial mail shot to case load of PDNS 400x 25p =£100.

Total for two years

Singing teacher £3080

Equipment £1100

SaLT time £1250

Postage £ 100

--------

total £5530

The funding came from a variety of sources. An unsuccessful application was made to the

National Parkinson’s Disease Society, however the West Midlands NHS Research and

Development Department provided funds, a local charity provided a substantial amount then

an anonymous donation made the whole project economically viable. There have since been

donations from other local charities.

Data Preparation

The Speech Therapists used the standard form for carrying out the six monthly Frenchay

Dysarthria Test.(annex one)

The participants completed a tick box PDQ39 form every six months.(annex two)

This data was than transferred to an anonymous spread sheet designed by the West Mids

Research and Development Team.

Data Analysis

The data analysis was undertaken by NHS Statistician. Summaries are presented using

mean, median and standard deviation of scores at the first and last time points.

For the 10 subjects where results were available at all five time points, the rate of change of

score was calculated for each item, and the rates of change tested using one-sample t tests to

see whether they differed from zero.

The results are shown in tables one and two. Not all 17 participants were able to complete the

two years, due to progression of disease or other personal reasons. It should be noted

however that the group has stayed at around 20 people as others have joined the sessions to

benefit from the singing.

The data is available for both the 17 that started the project and the 11 that finished.

Results

The results are summarized in tables one and two. Full results available in annex 3.

The Frenchay dysarthria scores are measured so that a higher score indicates improvement.

The data shows a small improvement in laryngeal time, pitch, volume and speech. There is

also a small improvement in dribble (one sample t test p=0.041), which is patient reported,

this is also reflected in some small improvement in tongue control.

The PDQ 39 measurement is scored so that a lower score indicates changes for the better as

reported by the patient. It has been demonstrated that changes of 0.2 are subjectively

meaningful to patients (Peto et al 2001) The data indicates that there was a small

improvement in social well being, stigma and communication.

For the 10 people who completed all five assessments, the Speech Therapist noticed a

difference in the following:

· Laryngeal time (mean 0.6 improvement, one sample t test p=0.10) measured by

asking patient to say “AH” for as long as possible.

· Laryngeal pitch (mean 0.8 improvement, one sample t test p=0.024) measured by

asking the patient to sing a scale.

· Laryngeal Volume (mean 0.9 improvement, one sample t test p=0.011) measured

by asking the patient to count to five increasing in volume on each number.

· Laryngeal Speech (mean 1.4 improvement, one sample t test p=0.001) measured by

noting whether the patient uses clear phonation, appropriate volume and pitch in

conversational speech.

The remaining items of the Frenchay Dysarthria Score did not show statistically significant

changes on one-sample t tests (Annex 3).

The PDQ39 is self reported and again there were some small improvements noted for the 10

people who completed the questionnaire on all five occasions particularly in communication

where an improvement of 0.36 mean was noted which according to Peto et al is meaningful

to patients.

None of the PDQ39 subscales showed a statistically significant change on one-sample t tests

(Annex 3).

Table One PDQ 39

Baseline Two years Baseline Two Years

Mobility Mobility Activities Activities

Valid 17 11 17 11

Mean 3.0529 3.0162 2.8980 2.2273

Median 2.9 2.8 2.6667 2.1667

Standard Deviation 1.1208 1.0689 1.0190 0.8275

Baseline Two Years Baseline Two Years

Emotional Emotional Stigma Stigma

Valid 17 11 17 11

Mean 2.0196 2.1364 2.0441 1.6818

Median 2.0 2.1667 2.0 1.25

Standard Deviation 0.7925 0.8590 0.8396 0.7339

Baseline Two Years Baseline Two Years

Social Social Cognitive Cognitive

Valid 17 11 17 11

Mean 1.8039 1.5606 2.1912 2.1818

Median 1.6667 1.3333 2.25 2.0

Standard Deviation 0.7459 0.6067 0.7832 0.7991

Baseline Two years Baseline Two Years

Communication Communication Discomfort Discomfort

Valid 17 11 17 11

Mean 2.2157 1.8788 2.6667 2.5303

Median 2.3333 1.6667 3.0 2.6667

Standard Dev 0.8893 0.6712 0.9204 1.0509

Table Two Frenchay Dysarthria Score.

Base

line

Two

years

Base

line

Two

years

Base

line

Two

years

Base

line

Two

years

Base

line

Two

years

Base

line

Two

years

Cough Cough Swallow Swallow Dribble Dribble Resp

rest

Resp

rest

Resp

spch

Resp

spch

Lips

rest

Lips

rest

Valid 17 11 17 11 17 11 17 11 17 11 17 11

Mean 7.47 7.55 7.65 7.36 6.88 7.82 8.06 8.45 8.35 8.09 8.65 8.73

Median 7.0 8.0 8.0 7.0 7.0 8.0 8.0 9.0 9.0 8.0 9.0 9.0

Std dev 1.546 1.508 1.412 1.433 1.728 1.250 1.144 0.820 0.996 0.944 0.786 0.647

Base

Line

Two

Years

Base

Line

Two

Years

Base

Line

Two

Years

Base

Line

Two

Years

Base

Line

Two

Years

Base

Line

Two

Years

Lip

seal

Lip

seal

Lips

Alt

Lips

Alt

Lips

Spch

Lips

Spch

Jaw

Rest

Jaw

Rest

Jaw

Spch

Jaw

Spch

Palt

fluids

Palt

fluids

Valid 17 11 17 11 17 11 17 11 17 11 17 11

Mean 9.0 8.45 8.18 8.36 8.53 8.36 8.94 8.64 8.82 8.27 8.65 8.64

Median 9.0 9.0 8.00 9.0 9.0 9.0 9.0 9.0 9.0 9.0 9.0 9.0

Stnd

Dev

.000 0.934 0.883 0.924 0.717 1.286 0.243 0.809 0.529 0.905 0.786 0.809

Baseline Two

years

Base

line

Two

years

Base

line

Two

Years

Base

line

Two

Years

Base

Line

Two

Years

Palate

Speech

Palate

Speech

Laryngl

Time

Laryngl

Time

Laryngl

Pitch

Laryngl

pitch

Laryngl

volume

Laryngl

volume

Laryngl

speech

Laryngl

speech

valid 17 11 17 11 17 11 17 11 17 11

mean 8.71 8.45 7.65 7.82 7.82 8.36 7.65 8.09 6.82 7.55

median 9.0 9.0 8.0 9.0 8 9.0 8.0 9.0 7.0 8.00

Std dev 0.686 0.934 1.801 1.601 1.510 1.206 1.45 1.578 1.704 1.572

Base

line

Two

years

Base

line

Two

years

Base

line

Two

Years

Baseline Two

Years

Base

line

Two

Years

Base

line

Two

Years

Tng

at

rest

Tng

at

rest

Tng

pro

Tng

pro

Tng

elev

Tng

elev

Tng Lat Tng

lat

Tng

Alt

Tng alt Tng

spch

Tng

spch

Valid 17 11 17 11 17 11 17 11 17 11 17 11

Mean 7.76 7.36 7.47 8.0 6.71 7.27 7.76 7.55 8.12 7.55 8.0 7.82

Median 8.0 7.0 7.0 9.0 7.0 9.0 8.0 8.0 8.0 7.0 8.0 8.0

Stand.De

v

1.39 1.433 1.328 1.183 1.795 2.284 1.393 1.635 0.92

8

1.368 0.935 1.168

Baseline Two Years Baseline Two Years Baseline Two Years

Intelligible

words

Intelligible

words

Intelligible

sentences

Intelligible

sentences

Intelligible

Conversation

Intelligible

Conversation.

Valid 17 11 17 11 17 11

Mean 8.29 8.55 8.82 8.27 7.94 8.09

Median 9.0 9.0 9.0 9.0 8.0 9.0

Standard

Deviation

1.359 1.036 0.728 1.421 0.966 1.136

Discussion

The purpose of this small pilot project was to ascertain whether group singing could provide

effective speech therapy for people with Parkinson’s. It is recognized by the project team that

there are limitations of this study. The small sample size implies that it is difficult to

generalize the findings and the measurements used are arguably subjective.

Parkinson’s disease itself is very variable and those volunteering to participate may reflect

people that like singing, rather than people with major voice problems.

It is also recognized that there was no control group. This was discussed at the beginning of

the project but the team decided that is was not possible to ask people with PD to have their

voices assessed but not offer them therapy. The standard speech therapy on offer is described

above and demonstrates that it would not continue for a two year period due to resources.

The project was also carried out by a very small busy team who were inexperienced in

research. The geographical area is large so travelling was an issue for some participants.

Parkinson’s is a progressive neurological disorder so deterioration in voice problems would

be expected over a two year period. It is therefore of some significance that no real

deterioration was noted in the speech of the participants, even though a small (less than 0.5)

deterioration was noted in lips and palette affecting swallowing, a common problem as PD

progresses. There were statistically significant improvements in the laryngeal elements of the

Frenchay Dysarthria Score over the two years. These results warrant the further investigation

of a more rigorous research project.

The small improvement in the PDQ 39 scores is reflected in the comments from the

participants. Those that have continued to attend throughout the project relate a definite

benefit both in communication skills and wellbeing. Many have said that they have noticed

positive changes in their voices and as a result have felt more confident. There is growing

recognition in health care of the expertise patients bring to the management of their own

illness. A project that was devised by a patient and is now run by patients and their partners,

has much to recommend to people coping with a chronic long term condition such as

Parkinson’s. The group are now going to offer the sessions to people with other long term

conditions such as Multiple Sclerosis, Strokes and Respiratory Conditions.

Of importance is that this form of voice therapy is very cost effective. The cost of the teacher

and the rent for the room is not affected by the number of participants. So if voice quality can

be maintained for a large number of people at a low cost, it offers an attractive proposition to

Commissioners of Health Care.

The project also received a Judges Award in the regional NHS health and Social Care

Awards and was recognized as “an innovative and exciting project that demonstrates the use

of professional skills in a very personal way”

Conclusion

This pilot project has offered a form of voice therapy to a small number of participants with

a degree of success. In a progressive neurological condition, the prevention of deterioration in

voice quality can be of significant benefit to the patient. The sessions are cost effective and it

is intended to continue the group and offer it to people with other conditions. Financing

further sessions will need to be negotiated between NHS and Voluntary Organisations.

To provide the clinical evidence required by Commissioners of Health Care may require a

more rigorous research project, however for those twenty people currently attending the

Singing as Therapy Sessions, it provides a vital form of support and promotion of vocal well

being.

References for Research study on:

Can Group Singing Provide Effective Speech Therapy for People with Parkinson’s.

Baker F, Wigram T. (2004)

The immediate and long term effects of singing on the mood states of people with Traumatic

Brain injury.

British Journal of Music Therapy.18 (2).

Baker F, Wigram T & Gold C. (2005)

The effects of a song-singing programme on the affective speaking intonation of people with

traumatic brain injury.

Brain Injury, July 2005;19(7):519-528

Baumgartner A, Sapir S, Ramig L (2001)

Voice Quality Changes Following Phonatory-Respiratory effort Treatment (LSVT) versus

Respiratory Effort Treatment for Individuals with Parkinson’s disease.

Journal of Voice 15, (1) 105-114.

Caroll L.2000

Application of singing techniques for the treatment of dysphonia.

Otolaryngologic clinics of North America Oct 2000,33(5) :1003-16

Cavanagh S, Millar A, McLafferty E 2007

The recognition and use of patient expertise on a unit for older people.

Nursing Older People. Oct 200719(8):31-36.

Deane KHO, Ellis-Hill C, Jones D et al (2002.)

Systematic review of paramedical therapies for Parkinson’s Disease.

Movement disorders17:984-991.

Deane KHO, Whurr R, Playford E.D , Ben-Shlomo Y, Clarke C.E (2001)

Speech and language therapy for dysarthria in Parkinson’s Disease: a comparison of

techniques.

Cochrane Database of Systemic Reviews 2001 Issue 2. Art no CD002814

Enderby. P. 1988

Frenchay Dysarthria Assessment Manual

The NFER-NELSON publishing company ltd

Gaudet P. (2002)

Measuring the impact of Parkinson’s Disease: An occupational therapy perspective.

The Canadian Journal of Occupational Therapy: April: 69(2)

Gillam T. (2006)

The hidden face of Parkinson’s disease.

British Journal of Neuroscience Nursing. 1(5)

Gotell E, Brown S, Ekman, SL. (2003)

Influence of care giver singing and background music on posture, movement and sensory

awareness in dementia care.

International Psychogeriatrics/IPA Dec 15(4):411-30

Graham D. (2007)

The Healing Power of Music

EPDA PLUS (European PD Association ) Winter 2007 issue 6

Haneishi,E. (2001)

Effects of Music Therapy Voice Protocol on Speech Intelligibility, Vocal Acoustic Meas