Tag Archives: Singing

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An early Spring, this year

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This February has seen no scenes like the one above (Feb. 15, 2021) where we saw over 6 inches of snow and sub freezing temperatures for about two weeks. Thousands of people lost power, and I don’t want to look up how many died from the pre-20th Century conditions to which they were not conditioned or prepared to deal with.

However, thanks to Global Warming, this Winter has been warm, for the most part. So we’ve seen some early blooms, one of which always persists, is the Ten-Petal Anemone. This bloom is white, but the species can vary from white through pinkish to violet. (An artist might differ with my choice of descriptive colors).

And here’s an unopened Anemone berlandieri from the violet end of the spectrum.

What are these doing in the Bob’s Brain: Living well with PD and other co-morbidities blog?

  • Bob’s brain mistakenly failed to switch to the Back to the natives: Native plants are the answer before beginning the draft, or
  • Bob’s brain has other interests in his life other than an incurable, progressive,  degenerative neurological disease,
  • or both of the above… whatever answer you choose, you won’t go wrong.

Oh well, might as well end with a song:

https://youtu.be/sxoTWy0bTXo?si=NmKkd0bLzysH8ZSO

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Music, movement, and PD

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Jerry Coker, who was one of my instructors my first year in undergraduate college, and then again my last semester before graduation , had an hypothesis that for improvisation to be enjoyable, it had to be approximately 75% predictable and 25% unpredictable. Vary too far from those parameters, and you end up with something that is either too boring and predictable, or something that leaves the listener wondering what’s going on, trying to guess where the melody is.

I never advanced far enough to get his insights on swing, or the concept of where the beat is. Duke Ellington, whom I saw at a festival once, did have a short primer on swing. He began with the person who snaps his fingers or taps his feet on the downbeats (ONE-and-TWO-and….). Then he progressed to the folks who tapped their feet or snapped their fingers on the upbeat (1-AND-two-AND..). I forget where it went from there (maybe to Latin rhythm patterns), although I do remember him saying that when he greeted people, he always gave two kisses to the right, and two to the left, one for each cheek.

Love You Madly (ending)

Today’s readings all relate to music and movement –

From  Saluja A, Goyal V, Dhamija RK. Multi-Modal Rehabilitation Therapy in Parkinson’s Disease and Related Disorders. Ann Indian Acad Neurol. 2023 Jan;26(Suppl 1):S15-S25. doi: 10.4103/aian.aian_164_22. Epub 2022 Nov 21. PMID: 37092020; PMCID: PMC10114534. 

(emphasis added to the section quoted below):

Dance, Music, and Singing Therapy in Pd Rehabilitation

Dancing may improve speed of movement, balance, wellbeing, and QOL in patients with PD.[74,75] Multiple dancing interventions and their impact on symptomatology of PD patients have been assessed. In a systematic review of 38 articles that studied the role of various dancing interventions (tango, waltz/foxtrot, Sardinian folk dancing, Irish set dancing, Brazilian samba, Zumba, mixed dance forms, and home-based dance interventions), there was a moderate-to-large beneficial effect of dancing interventions in mild-to-moderate PD. Dancing sessions (once/week to daily for 30 minutes to 2 hours) significantly improved balance, total UPDRS, mobility, endurance, gait freezing, and depression among PD patients.[76]

Music and rhythmic auditory stimulation can improve gait parameters in PD.[77] BEATWALK is a smartphone-based application that initially assesses cadence in PD patients and then progressively increases musical tempo in order to reach the desired speed. A recent study found that BEATWALK significantly improved gait velocity (P < 0.01), cadence (P: 0.01), stride length (P: 0.04), and distance (P: 0.01) among 39 PD patients who could walk unaided and had no gait freezing.[78] The ParkinSong trial studied the effect of singing intervention (at weekly and monthly intervals) in PD and found significant improvements in vocal intensity (P = 0.018), maximum expiratory pressure (P = 0.032), and voice-related QOL (P = 0.043) among PD patients when compared to controls.[79] A recent systematic review and meta-analysis including 67 publications found that tango resulted in significantly improved UPDRS-III scores (Z = 2.87, P = 0.004) and TUG scores (Z = 11.25, P < 0.00001), whereas PD-specific dance resulted in improvement in PDQ-39 scores (Z = 3.77, P = 0.0002) when compared to usual care.[80]

Cox L, Youmans-Jones J. Dance Is a Healing Art. Curr Treat Options Allergy. 2023 Apr 10:1-12. doi: 10.1007/s40521-023-00332-x. Epub ahead of print. PMID: 37361639; PMCID: PMC10088655.

This article is considered an Opinion Statement rather than a “research study,”although they used the same armchair/desk jockey methods used by many reviews and meta-reviews. From the abstract (emphasis added):

The purpose of this review is to evaluate the health benefits of dance and dance therapy in various health domains. Dance interventions included movement therapy with certified therapists, common dances such as ballroom dancing, salsa, and cha-cha as well as ethnic dances, such as the Chinese Guozhuang Dance and the Native American jingle dance. The health domains included depression, cognitive function, neuromotor function, dementia, balance, neurological growth factors, and subjective well-being. The National Library of Medicine, Congress of Library, and the Internet were searched using the terms: dance, dance movement therapy, health, cognitive function, healing, neurological function, neuromotor function, and affective disorders from 1831 to January 2, 2023. Two-thousand five hundred and ninety-one articles were identified. Articles were selected if they provided information on the health benefits of dance in one or more of the above domains as compared to a “non-dance” control population. Studies included systematic reviews, randomized controlled studies, and long-term perspective studies. Most of the subjects in the studies were considered “elderly,” which was generally defined as 65 years or older. However, the benefits of DI on executive function were also demonstrated in primary school children. Overall, the studies demonstrated that DI provided benefits in several physical and psychological parameters as well as executive function as compared with regular exercise alone. Impressive findings were that dance was associated with increased brain volume and function and neurotrophic growth function. The populations studied included subjects who were “healthy” older adults and children who had dementia, cognitive dysfunction, Parkinson’s disease, or depression.

The benefits of dance for PwPs include movements and connections with others:

Jola C, Sundström M, McLeod J. Benefits of dance for Parkinson’s: The music, the moves, and the company. PLoS One. 2022 Nov 21;17(11):e0265921. doi: 10.1371/journal.pone.0265921. PMID: 36409733; PMCID: PMC9678293.

From the abstract:

Dance classes designed for people with Parkinson’s are very popular and associated not only with increasing individuals’ motor control abilities but also their mood; not least by providing a social network and the enjoyment of the music. However, quantitative evidence of the benefits is inconsistent and often lacks in power. For a better understanding of the contradictory findings between participants’ felt experiences and existing quantitative findings in response to dance classes, we employed a mixed method approach that focussed on the effects of music. Participant experience of the dance class was explored by means of semi-structured interviews and gait changes were measured in a within-subjects design through the Timed Up and Go (TUG) test before and after class, with and without music. We chose the TUG test for its ecological validity, as it is a simple test that resembles movements done in class. We hypothesised that the music and the dance class would have a facilitating effect on the TUG performance. In line with existing research, we found that before class, the gait of 26 participants was significantly improved when accompanied by a soundtrack. However, after class, music did not have a significantly facilitating effect, yet gait without music significantly improved after class compared to before.We suggest that whilst the music acts as an external stimulator for movement before the dance class, after the dance class, participants have an internalised music or rhythm that supports their motor control. Thus, externally played music is of less relevance. The importance of music was further emphasised in the qualitative data alongside social themes. A better understanding of how music and dance affects Parkinson’s symptoms and what aspects make individuals ‘feel better’ will help in the design of future interventions.

The entire article is Open Access at the link above. My own impression of the discussion of the contradictory results (from what was expected) reminded me of a quote my statistics professor was fond of repeating: It is meaningless to discuss what the data might have been if the data were something other than what they are. 

As a PwP, one explanation for the lack of significance difference in the TUG post-test could very well be fatigue. I, therefore, suggest that this could be looked into as a possible explanation for the lack of significant difference between external music v no external  music stimulus. Clearly, “Further research is needed.”

Morris ME, McConvey V, Wittwer JE, Slade SC, Blackberry I, Hackney ME, Haines S, Brown L, Collin E. Dancing for Parkinson’s Disease Online: Clinical Trial Process Evaluation. Healthcare (Basel). 2023 Feb 17;11(4):604. doi: 10.3390/healthcare11040604. PMID: 36833138; PMCID: PMC9957486.

The above citation reports on a clinical trial which was conducted with a fairly large and coordinated collaborative effort. Again, an excerpt from the abstract:

Results: Twelve people with PD, four dance instructors and two physiotherapists, participated in a 6-week online dance program. There was no attrition, nor were there any adverse events. Program fidelity was strong with few protocol variations. Classes were delivered as planned, with 100% attendance. Dancers valued skills mastery. Dance teachers found digital delivery to be engaging and practical. The safety of online testing was facilitated by careful screening and a home safety checklist. Conclusions: It is feasible to deliver online dancing to people with early PD.

As a PwP who has participated in Power for Parkinson’s online video dance Rhythm and Moves and other exercise videos, both live and asynchronously, the last line comes as no surprise.

The hour grows late, and I have medications to take before I sleep, oh so many medications to take before I sleep. To sleep, perchance to dream…

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World Parkinson’s Day

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Don’t know if it’s a cause for celebration or awareness, but here it is. World Parkinson’s Day , April 11, 2023. (If I managed to get my days right – seems I’m correct).

Anyway, to commemorate this day, I shall present some of my songs and “Parkinson’s Parodies©” that I’ve composed and or written lyrics to since having been diagnosed with Parkinson’s Disease in late 2011:

Submitted to the World Parkinson’s Coalition (WPC) this year as an entry in their song contest an original tune;

No Estoy Borracho

Also submitted to the WPC, a “Parkinson’s Parody©” based on Fleetwood Mac’s song “Don’t Stop”:

Don’t Stop Moving To The Music

Previously submitted to the WPC, but not this year,

Parkinson’s Anthem (We Ain’t Givin’ Up Hope”

… And that’s enough for today… I have an appointment with my Movement Disorders Specialist and so I gotta go now.

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Prodromal symptoms, Parkinson’s Disease (PD), and that old song and dance…

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Here’s a few studies that came up in my news feed from  PubMed Central (PMC) or elsewhere for articles recently published on the topics in which I’m interested – namely, prodromal symptoms related to PD, the relationship of REM sleep disorder and depression to PD, and, of course, the use of singing and dance therapies as complementary approaches to dealing with the symptoms of PD.

Prevalence and duration of non-motor symptoms in prodromal Parkinson’s disease

The prevalence and duration of non-motor symptoms (NMS) in prodromal Parkinson’s disease (PD) has not been extensively studied. The aim of this study was to determine the prevalence and duration of prodromal NMS (pNMS) in a cohort of patients with recently diagnosed PD.

…subtracted the duration of the presence of each individual NMS reported from the duration of the earliest motor symptom. NMS whose duration preceded the duration of motor symptoms were considered a pNMS. Individual pNMS were then grouped into relevant pNMS clusters based on the NMSQuest domains. Motor subtypes were defined as tremor dominant, postural instability gait difficulty (PIGD) and indeterminate type according to the Movement Disorder Society Unified Parkinson’s Disease Rating Scale revision.

Results: Prodromal NMS were experienced by 90.3% of patients with PD. … males reporting more sexual dysfunction, forgetfulness and dream re-enactment, whereas females reported more unexplained weight change and anxiety. There was a significant association between any prodromal gastrointestinal symptoms and urinary symptoms  and the PIGD phenotype.[n.b.: phenotype includes inherent traits or characteristics that are observable]. [Emphases added].

Citation:  Durcan R, Wiblin L, Lawson RA, Khoo TK, Yarnall AJ, Duncan GW, Brooks DJ, Pavese N, Burn DJ; ICICLE-PD Study Group. Prevalence and duration of non-motor symptoms in prodromal Parkinson’s disease. Eur J Neurol. 2019 Jul;26(7):979-985. doi: 10.1111/ene.13919. Epub 2019 Mar 1. PMID: 30706593; PMCID: PMC6563450.

Associations of Sleep Disorders With Depressive Symptoms in Early and Prodromal Parkinson’s Disease

Purpose: To explore the effect of sleep disorders, including the probable rapid eye movement (REM) sleep behavior disorder (pRBD) and the daytime sleepiness, on depressive symptoms in patients with early and prodromal PD.

5-year follow-up study showed that sleep disorders, including pRBD and daytime sleepiness, were associated with the increased depressive-related score in individuals with early and prodromal PD.

Conclusion: … Sleep disorders, including pRBD and daytime sleepiness, are associated with depression at baseline and longitudinally, …  partially mediated by the autonomic dysfunction in early and prodromal PD, …  implication that sleep management is of great value for disease surveillance.

Citation: Ma J, Dou K, Liu R, Liao Y, Yuan Z, Xie A. Associations of Sleep Disorders With Depressive Symptoms in Early and Prodromal Parkinson’s Disease. Front Aging Neurosci. 2022 Jun 10;14:898149. doi: 10.3389/fnagi.2022.898149. PMID: 35754965; PMCID: PMC9226450.

Group therapeutic singing improves clinical motor scores in persons with Parkinson’s disease

Abstract
Background Previous reports suggest that group therapeutic singing (GTS) may have a positive effect on motor symptoms in persons with Parkinson’s disease (PD).

Objective To determine the effect of a single session of GTS on clinical motor symptoms.

Methods Clinical motor symptom assessment was completed immediately before and after 1 hour of GTS in 18 participants.

Results A significant decrease in average scores for gait and posture and tremor, but not speech and facial expression or bradykinesia was revealed.

Conclusion These results support the notion that GTS is a beneficial adjuvant therapy for persons with PD that warrants further research.

Citation: Stegemoller E, Forsyth E, Patel B, et al. Group therapeutic singing improves clinical motor scores in persons with Parkinson’s disease BMJ Neurology Open 2022;4:e000286. doi: 10.1136/bmjno-2022-000286

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Sing!

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What research has found its way into the email inbox recently?

Although singing is a nearly universal human behavior, many adults consider themselves poor singers and avoid singing based on self-assessment of pitch matching accuracy during singing (here referred to as singing accuracy), in contrast to the uninhibited singing exhibited by children. In this article, I report results that shed light on how singing accuracy changes across the lifespan, using data from a large online sample, including participants ranging from 6 to 99 years old. Results suggest that singing accuracy improves dramatically from childhood to young adulthood, unperturbed by voice changes during adolescence, and remain at a similarly high level for the remainder of life, exhibiting no strong tendency toward age-related decline. Vocal or instrumental musical training has significant positive effects on singing accuracy, particularly in childhood, though there was no evidence for gender differences. Finally, pitch discrimination varied with age similarly to singing accuracy, in support of views that singing accuracy reflects sensorimotor learning. Taken together, these results are consistent with the view that singing accuracy is a learned motor skill that benefits from engagement and can remain a fruitful endeavor into old age. (emphasis added).

citation: Singing accuracy across the lifespan
Peter Q. Pfordresher preprint  article accessed 6-19-22 at https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14815

Basically, this says that if you learned how sing accurately when you were young, you can probably sing well into your later years. And, since singing is a learned motor skill, one might assume that it can be learned even as one gets older.

Relevance to folks with Parkinson’s Disease (PD)?

Vocal strength exercises, such as those provided by Power for Parkinson’s as free YouTube video classes, can help with specific Parkinson’s related symptoms:

Many people with PD speak quietly and in one tone; they don’t convey much emotion. Sometimes speech sounds breathy or hoarse. People with Parkinson’s might slur words, mumble or trail off at the end of a sentence. Most people talk slowly, but some speak rapidly, even stuttering or stammering.

Parkinson’s motor symptoms, such as decreased facial expression, slowness and stooped posture, may add to speech problems. These can send incorrect non-verbal cues or impact the ability to show emotion. Source: https://www.michaeljfox.org/news/speech-swallowing-problems accessed June 20, 2022  (emphasis added).

Since our vocal cords are muscles, and singing is a learned motor skill, we can strengthen those muscles and push against the progressive, degenerative symptoms of PD through exercises that:

  • remind us to breathe deeply to sustain vocal volume,
  • improve our posture in order to enable deep breathing,
  • exercise the muscles of the face and mouth
  • to enable crisp diction instead of slurring and mumbling, and that
  • support emotional expression through inflection and singing.

And “Everybody Knows” that if exercise is fun, one is more likely to continue doing it.

Full disclosure: The author has attended Power for Parkinson’s ® vocal exercise classes since their inception in 2016, and co-founded a participant organized singing group (with the late Jeff Berke) in 2015.  Therefore, he might be (definitely is) biased in favor of this modality of treatment for vocal and speech related symptoms of PD.

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Say what?

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Not specifically related to Parkinson’s, this study looked into whether providing musical training to older non-musicians would have an effect on the experimental task.

Experienced musicians outperform non-musicians in understanding speech-in-noise (SPIN). The benefits of lifelong musicianship endure into older age, where musicians experience smaller declines in their ability to understand speech in noisy environments…  results suggest that short-term musical training in older adults may enhance neural encoding of speech, with the potential to reduce age-related decline in speech perception. [emphasis added]

The effects of short-term musical training on the neural processing of speech-in-noise in older adults

… these findings suggest that music training enhances neural responses to speech in speech-motor and control regions.The absence of training-related interactions with noise level suggests that the benefit of music training is related to processing speech in general, and not separating it from background noise;

– BUT analysis of functional Magnetic Resonance Imaging showed electrical activities in a couple of areas of the brain related to speech perception for those who were in the musical training group.

Obviously, “further research is needed,” as the saying goes, and perhaps for longer periods of time.

Whatever type of musical training one chooses, singing, keyboard, string, or wind instruments, there’s another saying that applies to that as well: “It may not help, but it can’t hurt.”

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Music on the brain

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Why do we like some kinds of music but not others?

Back in college, Jerry Coker (who taught jazz improvisation, said that we tended to like music that was not entirely predictable, but that a certain level of surprise increased our enjoyment of jazz. Music that was too unpredictable led to diminished enjoyment. Now, a study has been done that mathematically analyzed people’s enjoyment of musical snippets, and basically confirmed what Jerry taught us. Surprise us every now and then, but don’t make us feel like we’re stupid and can’t guess the next note that’s coming along.

Here’s the article with a reference and link to the original research (if you can afford it): The brain’s favorite type of music

Dopamine’s role in music enjoyment.

In this study, researchers looked at people’s responses to music under three separate conditions. One group received levodopa, another received risperidone, a dopamine antagonist, and a third group received a placebo. Folks in the levodopa group reported and were recorded as having higher levels of enjoyment, and those taking the antagonist, lower levels of enjoyment. Each group[ went through all the conditions, separated by a week in between sessions. The results clearly indicate that dopamine is the brain is related to musical pleasure. Now, if  playing and singing music promote an increase of dopamine in the brain, we have a prescription for Parkinson’s Disease (and depression) that can’t be beat (although it can be counted off).

Dopamine role in musical pleasure    

the actual research article which appears to be available in its entirety online: Dopamine modulates the reward experiences elicited by music

 

 

 

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Kazoos are good for youse

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All of the following links have to do with improving voice for PD folks, and also the use of kazoos.

I used to write for this student newspaper:

Music therapy helps tackle Parkinson’s (The Miami Hurricane July 5, 2019)

This is a fairly long honors project paper reviewing voice therapy techniques:

Voice Therapy Techniques in Combination with the Group Therapy Setting for Individuals withParkinson’s Disease

Not necessarily for PD, but the study used spectrographic analysis to measure the improvement in voice in addition to qualitative results.

Finger Kazoo: spectrographic acoustic modifications and vocal self-assessment

I might have already mentioned this in a previous entry, but kazoos were used:

Individual Therapeutic Singing Program for Vocal Quality and Depression in Parkinson’s Disease

Vocal warmups for the individual: Vocal warmups

Vocal warmups for the group: Anatomy of a choral warmup

 

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I got rhythm, I got music…

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Put together a slide presentation trying to synthesize some of the research on Parkinson’s Disease (PD) and the possibility of music, singing, playing musical instruments, and dance as means to counteract the progressive effects of dopaminergic neurons lost in the course of PD. Due to the length of the presentation and the limits of my computer resources, the narration seems to have gotten a little out of sync towards the end. But it is what it is, as they say: (note: added a PDF file of the presentation on 6-9-19 to make it easier to download and view)

Rhythm, Music, Singing, Dancing and the Brain

2019-06-05-Rhythm Music Singing and the brain  (PDF file)

and an even smaller file with all the blue and yellow intact (6-15-2019):

Rhythm Music Singing Dancing and the Brain

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Dance, aerobic exercise and musical training

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Today we have a couple of links to articles on the effects of dance and music:

Effects of Dance/Movement Training vs. Aerobic Exercise Training

Abstract only, but the results appear to be in favor of Dance Movement Therapy (DMT) as positive. Aerobic Exercise Therapy (AET) improved cardiovascular health, though, so both aerobic and dance movement therapies should be used for health.

Executive and non-executive composite scores showed a significant increase post-training (F(1,37)=4.35, p=.04; F(1,37)=7.01, p=.01). Cardiovascular fitness improvements were specific to the AET group (F(2,38)=16.40, p<.001) while mobility improvements were not group-dependent (10m walk: F(1,38)=11.67, p=.002; Timed up and go: F(1,38)=22.07, p<.001).
Results suggest that DMT may have a positive impact on cognition and physical functioning in older adults however further research is needed. This study could serve as a model for designing future RCTs with dance-related interventions.

Next, a short article on the effects of musical training on brain plasticity.

The-Effects-of-Musical-Training-on-Brain-Plasticity-and-Cognitive-Processes

The link between musical training and its effects on brain plasticity have been studied since the early 20thcentury neuroanatomy research of Ramon y Cajal. In recent decades, studies have observed the contributions of musical training in enhancing auditory, motor, and language processing areas of the brain. The ability of musical training to impact behavior and critical thinking skills may also open the door for new methods of combating age-and illness-related cognitive decline(emphasis added)

In conclusion, whether or not one has a neurodegenerative disease or not, it is good advice to do aerobic exercise for the heart, dance for the mobility, and learn or continue to play a musical instrument to keep the brain plastic and elastic and fantastic.

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