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Kaitlyn Aquino • Jul 06, 2023

Music and the Voice – Aphasia and Stroke

According to the Heart and Stroke Foundation, stroke is the leading cause of disability in adults in Canada. The annual occurrence rate has increased to 108,707 which equates to approximately one stroke every five minutes. With the rapidly aging population in Canada, the prevalence of stroke is only expected to increase. And with that, a growing need for strong stroke care.

 

With stroke, one of the most common side effects is impaired speech. Some stroke survivors may experience dysarthria (muscle control difficulties), apraxia (muscle coordination difficulties) or aphasia.

 

Aphasia is a language disorder that can result in difficulties with speaking, reading, writing and understanding speech, depending on the type of aphasia. Research indicates that aphasia occurs in 25-50% of individuals post-stroke. While there are several types of aphasia, we’re going to focus on Broca’s aphasia. Sometimes referred to as an expressive or non-fluent aphasia, Broca’s aphasia is characterized by diminished speech output. Persons with Broca’s aphasia may be able to comprehend speech but have difficulty producing speech.

 

So how does music come into play?

 

Melodic Intonation Therapy (MIT) uses the melodic and rhythmic elements of singing words and phrases to aid in speech recovery. This technique is used with patients who have aphasia. Several studies have indicated that the Neurologic Music Therapy technique MIT can help reroute speech pathways from the damaged left hemisphere to the language-capable regions of the right hemisphere (Thaut & Hoemberg, 2016, p. 141).

 

In MIT the therapist begins with humming, then singing and gradually moves into speaking. The therapist may employ a vocal technique called sprechgesang. In sprechgesang, the therapist uses their voice in an expressive manner, halfway between singing and speaking. Throughout the exercise, the therapist also taps the client’s left hand.

 

Why the left hand? MIT can help reroute speech from the left to the right hemisphere. This is because our brain is organized contralaterally. This means when we tap our left hand we are activating the right side of our brain! Research by Gentilucci and Dalla Volta (2008) also indicates that left hand tapping activates right hemispheric language networks.

 

You may have even heard of MIT in the news before. Congresswoman Gabby Giffords suffered a traumatic brain injury, and was diagnosed with aphasia. MIT was part of her journey to recovering her ability to speak. This is just one way music can be used in speech rehabilitation.

 

It can be difficult to watch a loved one experience the loss of their ability to speak. The beauty of music is that it can aid in rehabilitating the voice while encouraging meaningful moments of connection with others.

 


By Shelley Neal 08 Mar, 2024
I initially trained with MUSIC CARE to work with Seniors in Long Term Care who were experiencing dementia and Alzheimer’s Disease. This is the path I travelled with my mom. My training with Music Care and Room 217 supported capacity building in selecting music that was played on my harp or chosen recorded music. The music centered on the care of the individual and their specific needs. My job was to determine the individual’s specific and select music to address these needs. The music selected helped to build community, support sleep, talk about life experiences, create a background landscape of sound, support connection to decrease isolation and loneliness, as well as coming alongside people dying. My training with Music Care helped me understand how to support people “where they were” physically, emotionally, and spiritually. Through using beat, tempo, melody, and timbre, I could cater the music and desired support required for individuals or small groups. My profession is teaching. I am a special education teacher and use music in my primary teaching as a method for learning, practicing language skills, transmitting information about science studies or math equations, as well as having fun and creating our own songs. My teacher toolkit married exceptionally well with the knowledge and skills provided by the Music Care Certification training. Recently, my work with students has involved individual programming for the medically fragile children and the palliative children. I use music (repeating the chorus several times) to engage and connect with the kiddos. We use music to "talk" about feelings (our communication is through eye gaze, eye blinks, and squeezing hands), and content material. I use music to enjoy our relationship of being together. At times, due to medication for seizures, my little ones can be very sleepy. I increase the tempo, engaging in tapping the beat on her hands and using silly action songs. The giggles and wiggles make it magical. I also use music to tell stories (my students have CVI, cortical vision impairment, so visual perception is difficult). This helps the child to engage in the story arch and adventures. Music is my conduit for reaching out and being with the students. Recently, I had the sacred journey of visiting one of my children in ICU at Sick Kids. I was invited to come to say "goodbye". A dear friend who was an ICU nurse in a different department told me (AKA, insisted) that I bring my harp with me. I wasn't sure if this would be appropriate for the family. However, with the permission of the mom, I bravely packed my harp up and took it to the Unit. It was a beautiful evening of talking with their mom and dad about how special their child was in my life. I played the kiddo's favorite songs and then ended with "The More We Get Together". The little one opened their eyes and stared at me. We hugged, and I left. They passed the next morning. I consider this time to be a sacred gift. Music Care Certification has given me the confidence and toolset to work alongside people and to journey together. It is a time a beautiful, difficult, or sacred time that I have been honoured to participate in.  Thank You
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