Choral singing therapy following stroke or Parkinson's disease: an exploration of participants' experiences

Stronger Together: A Qualitative Exploration of Social Connectedness in Parkinson's Disease in the Digital Era

PURPOSE

Social isolation is a common consequence of Parkinson's disease (PD), and social prescribing has become a crucial aspect for fostering well-being in this population. In fact, group work has been shown to improve levels of social connectedness in older adults across different domains. Increased technology use in older adults may also contribute to increased social connections, especially since the COVID-19 pandemic. Still, the impact of digital use on social connectedness remains to be further explored in individuals with PD. Therefore, the purpose of this study was to examine the perceptions of social connectedness in relation with group-based activities and use of digital technologies in this population.

METHOD

Ten individuals with PD participated in focus groups. Transcripts of the video-recorded groups were analyzed qualitatively using thematic analysis.

RESULTS

The three constructed themes not only revealed changes and challenges in social connectedness but also underscored the power of family and new relationships established through PD. Results also highlighted the overall positive impact of current digital technologies, although the view on telehealth per se was multifaceted.

CONCLUSIONS

Referrals for group rehabilitation programs can enhance social connectedness in individuals with PD through fostering new social connections and community building. Hence, group rehabilitation programs should be viewed as a form of social prescribing. The use of digital technologies should be further explored as a means to maximize social engagements in this population.

The role of an inpatient aphasia-friendly choir for people with post-stroke communication impairment from the perspective of the multidisciplinary team: An exploratory study

BACKGROUND

There is a growing body of evidence showing the value of community singing-based rehabilitation on psychosocial well-being and communication for people with post-stroke communication impairment (PSCI). However, there has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the perspective of the stroke multidisciplinary team (MDT).

AIMS

To explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir, at a stroke rehabilitation centre in South Wales, UK, may play in the rehabilitation of people with PSCI.

METHODS & PROCEDURES

Eight participants were recruited from the stroke rehabilitation centre's MDT. Semi-structured interviews were conducted and the verbatim transcripts were analysed using thematic analysis according to Braun and Clark's work of 2006.

OUTCOMES & RESULTS

Four main themes were identified: (1) breaking down social isolation barriers; (2) patient voice and patient choice; (3) collective well-being and engagement; and (4) the therapeutic benefits across the MDT. The experiences and perceptions overlap, highlighting the wide-reaching therapeutic benefits of singing collaboratively.

CONCLUSIONS & IMPLICATIONS

This research enables us to discover more about how the inpatient aphasia-friendly choir may enhance an individual's well-being, communication and confidence, and their overall rehabilitation from the MDT's perspective. By increasing our understanding of which aspects of the aphasia-friendly choir are most valued, future choir sessions can be better tailored to patients' needs. Additionally, the findings presented here could be taken forward and included in future speech and language therapy interventions, leading to increased patient ownership, not only of the choir but also of their other therapy goals.

WHAT THIS PAPER ADDS

What is already known on this subject Previous research suggests positive implications for therapeutic collaborative singing on psychosocial well-being and communication for people with PSCI. There has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the lens of the stroke MDT. The aim of this research was to explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir may play in the rehabilitation of people with PSCI. What this paper adds to the existing knowledge This research highlights the benefits of an inpatient aphasia-friendly choir for an individual's well-being, communication and confidence. An increased understanding enables future choir sessions to be better tailored to patients' needs. What are the potential or actual clinical implications of this work? Participating in the choir was felt to offer an increased opportunity for functional therapy goals in an inpatient setting. The MDT frequently discussed the choir's ability to 'normalise' therapeutic approaches for the patients. A greater understanding of the choir participants empowers therapists to personalise therapy plans further, facilitating effectiveness, efficiency and holistic practice.

Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review

PURPOSE

Stroke is one of the leading causes of disability with life-long implications requiring assessment and treatment of several functional domains. This review identifies the results from research into music-based interventions (MBIs), including music therapy (MT), for executive functions (EFs) and emotional well-being (EWB) in adults with stroke and highlights opportunities for clinical practice and future research.

METHODS

APA PsycInfo (EBSCOhost), and CINAHL (EBSCOhost) were searched, in addition to grey literature.

RESULTS

A total of 49 studies were included and encompassed experimental, analytic, and descriptive observational studies, and case reports, involving a total of 1663 participants. In total, 32 studies included MT interventions, and 17 were MBIs. EFs were an outcome in 20.41%, and EWB in 61.22% of studies, for which active interventions were the most utilized. Overall, 73.47% of the studies reported positive results.

CONCLUSIONS

This scoping review indicates that music interventions can be beneficial for the improvement of different aspects of EFs and EWB at different stages of stroke recovery. Further research may benefit clinical practice by including standardized protocols, outcome and self-reported measures, and brain imaging data to determine the effects of interventions and support evidence-based decisions for treatment policies for stroke survivors.

Effectiveness of Singing-Based Therapy on Voice Outcomes in Parkinson's Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Communication impairments significantly impact the quality of life for individuals with Parkinson's disease (PD), underscoring the need for effective interventions. Singing, by engaging shared neural networks and structural mechanisms involved in speech production, holds therapeutic potential for addressing speech disorders in this population. This study explores the effects of singing-based therapeutic intervention on voice in patients diagnosed with PD.

METHODS

We systematically searched four electronic databases to find relevant studies. Data extraction and analysis involved calculating mean differences (MD) or standardized mean difference (SMD) for pre- and post-singing interventions, including their 95% confidence intervals (CI). Statistical significance was evaluated with a P-value threshold >0.05.

RESULTS

Our systematic review and meta-analysis included 21 studies, encompassing 449 patients. Singing showed no significant effect on speaking fundamental frequency (MD 2.98, 95% CI: -6.79, 12.75, P = 0.55), jitter (MD -0.13, 95% CI: -0.47, 0.22, P = 0.47), shimmer (MD -0.71, 95% CI: -1.68, 0.26, P = 0.15), or health-related quality-of-life outcomes: Voice Handicap Index (MD -4.60, 95% CI: -9.29, 0.09, P = 0.05) and Voice-Related Quality of Life (SMD 0.08, 95% CI: -0.28, 0.44, P = 0.65). However, singing significantly improved vocal frequency range (MD 2.60, 95% CI: 1.17, 4.03, P = 0.0004), maximum expiratory pressure (MD 14.26, 95% CI: 9.57, 18.96, P < 0.00001), maximum inspiratory pressure (MD 6.22, 95% CI: 2.96, 9.48, P = 0.0002), and maximum phonation time (MD 1.83, 95% CI: 0.73, 2.92, P = 0.001). Vocal intensity showed no significant difference (MD 1.09, 95% CI: -0.71, 2.88, P = 0.24).

CONCLUSION

Our study found that singing interventions positively affect vocal frequency range and respiratory outcomes. However, significant changes were not observed in other speech metrics.

The use of music and music-related elements in speech-language therapy interventions for adults with neurogenic communication impairments: A scoping review

BACKGROUND

A growing body of research indicates that music-based interventions show promising results for adults with a wide range of speech, language and communication disorders.

AIMS

The purpose of this scoping review is to summarize the evidence on how speech-language therapists (SLTs) use music and music-related elements in therapeutic interventions for adults with acquired neurogenic communication impairments.

METHODS

This scoping review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search of three databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and OVID Medline) was conducted and articles were included if they (1) incorporated adult human participants; (2) received an assessment or intervention facilitated by an SLT; (3) incorporated techniques and interventions which included music-related elements (e.g., rhythm, melody, harmony and dynamics); (4) were written in the English language; and (5) were peer-reviewed full-text articles. Data were extracted using the Rehabilitation Treatment Specification System framework.

MAIN CONTRIBUTION

A total of 25 studies met the inclusion criteria. The studies included participants with neurogenic communication impairments secondary to stroke, Parkinson's disease, dementia and traumatic brain injury. Musical interventions identified in the studies were Melodic Intonation Therapy, Modified Melodic Intonation Therapy, choral singing, singing therapy and songwriting. The majority of the studies reported interprofessional collaboration between SLTs and at least one other healthcare clinician and/or musician. Many studies also included music-based interventions lead and facilitated by musically trained SLTs.

CONCLUSION

The results of the studies included in this review indicate that SLTs are using music-based interventions to target therapeutic goals to improve speech, language, voice and quality of life in collaboration with other clinicians and professional musicians.

WHAT THIS PAPER ADDS

What is already known on this subject A growing body of research indicates that interventions using music (i.e., choirs and songwriting) and musical elements (i.e., rhythm and dynamics) show promising results for adults with neurogenic communication impairments. Currently, however, there is no clear indication of how speech-language therapists (SLTs) are using music in their clinical practice. What this study adds This scoping review collates the current evidence on how SLTs use music and musical elements in their clinical practice. SLTs are using music and musical elements for individuals with neurogenic communication impairments in populations such as Parkinson's disease, dementia and traumatic brain injury. Common interventions described in the literature include Melodic Intonation Therapy, choral singing, singing therapy and songwriting. What are the clinical implications of this work? Many SLTs collaborate when delivering music-based interventions, particularly with music therapists (MTs). This scoping review suggests that SLTs should continue to explore music-based interventions in collaboration with MTs and professional musicians to target therapeutic goals to improve speech, language, voice and quality of life.

The potential of arts therapies in Parkinson's disease rehabilitation: A comprehensive review

Background and purpose

Parkinson's disease (PD) causes a decline in motor function, cognitive decline, and impacts the mental health of patients. Due to the high cost and side effects of conventional treatments, the medical community has begun to explore safer and more cost-effective alternative therapies. In this context, arts therapies have gained increasing attention as innovative treatments. This review plans to explore the role and potential of various arts therapies in the rehabilitation of PD patients by analyzing existing literature and case studies.

Methods

This review comprehensively searched the literature in several databases, including PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure, to assess the effectiveness of different arts therapies in the rehabilitation of patients with PD.

Results

From 3440 articles screened, 16 met the inclusion criteria. These studies included a variety of therapies, including music, meditation, yoga, art, dance, theatre, video games and play therapy. These different types of arts therapies had a positive impact on the motor, psychological and cognitive rehabilitation of PD patients, respectively.

Conclusion

The existing literature highlights the great potential of arts therapies in the rehabilitation of people with PD, further confirming the efficacy of arts therapies in enhancing the motor, psychological and cognitive rehabilitation process of people with PD. In addition, this review identifies research gaps in the use of color therapy in PD rehabilitation and highlights the need for further exploration of various arts therapies modalities.

Effects of SPEAK OUT! & LOUD Crowd on Functional Speech Measures in Parkinson's Disease

PURPOSE

This study investigated the effects of the SPEAK OUT! & LOUD Crowd therapy program on speaking rate, percent pause time, intelligibility, naturalness, and communicative participation in individuals with Parkinson's disease (PD).

METHOD

Six adults with PD completed 12 individual SPEAK OUT! sessions across four consecutive weeks followed by group-based LOUD Crowd sessions for five consecutive weeks. Most therapy sessions were conducted via telehealth, with two participants completing the SPEAK OUT! portion in person. Speech samples were recorded at six time points: three baseline time points prior to SPEAK OUT!, two post-SPEAK OUT! time points, and one post-LOUD Crowd time point. Acoustic measures of speaking rate and percent pause time and listener ratings of speech intelligibility and naturalness were obtained for each time point. Participant self-ratings of communicative participation were also collected at pre- and posttreatment time points.

RESULTS

Results showed significant improvement in communicative participation scores at a group level following completion of the SPEAK OUT! & LOUD Crowd treatment program. Two participants showed a significant decrease in speaking rate and increase in percent pause time following treatment. Changes in intelligibility and naturalness were not statistically significant.

CONCLUSIONS

These findings provide preliminary support for the effectiveness of the SPEAK OUT! & LOUD Crowd treatment program in improving communicative participation for people with mild-to-moderate hypokinetic dysarthria secondary to PD. This study is also the first to demonstrate positive effects of this treatment program for people receiving the therapy via telehealth.

Perceptual consequences of online group speech treatment for individuals with Parkinson's disease: A pilot study case series

PURPOSE

We examined perceptual changes in the domains of ease of understanding, naturalness, and speech severity, as well as changes in self-perceptions of voice disability, following an online group speech treatment program for people with Parkinson's disease (PD) conducted during the COVID-19 pandemic.

METHOD

Seven speakers with hypokinetic dysarthria associated with PD participated in a university and community-based online group speech program for 10 weeks. Speech recordings occurred remotely 1 week before and 1 week after the online program. Thirty naïve listeners rated ease of understanding, naturalness, and speech severity based on the speech recordings. Speakers' self-perceptions of voice disability were also obtained at both time points.

RESULT

Individual analysis of the speech data showed that for most speakers with dysarthria, ease of understanding and perceptions of severity were rated the same or better pre- to post-treatment. Naturalness, however, was only perceived to be the same or better post-treatment in three out of seven speakers. Over half of the speakers reported improvements in their self-perception of voice disability.

CONCLUSION

This pilot study highlighted the individual variability among speakers with dysarthria and the potential of online group speech treatment to maintain and/or improve speech function in this population.

It's quite good fun: A qualitative study of a singing/songwriting programme for people with Parkinson's disease and their spouses

BACKGROUND

Group singing for people with Parkinson's disease (PD) is an established intervention not only to improve voice and speech difficulties but also for emotional and social benefit. Less is known about the experiences of group singing on the couple-the person with PD and their spouse or partner together-and studies have not specifically tracked impact through time or in combination with songwriting.

AIMS

To understand the impact of group singing/songwriting on couples (participants with PD and their spouses) to unpack whether this broader view might help explain why such interventions are reported as beneficial. Using a trajectory approach, a form of longitudinal research and focused ethnography, the research sought a deeper appreciation of participation through time for the couple in a singing/songwriting group.

METHODS & PROCEDURES

Four couples attending a singing/songwriting programme were observed for 10 weeks, and interviewed formally and informally weekly. Data were analysed thematically across-case through framework analysis but also within-case to explore the couples' experiences and narratives over time.

OUTCOMES & RESULTS

The theme of 'improved relationships' between the couples was new and extended previous studies' findings of positivity, physical benefit, sense of self and social opportunity. The stories of each couple highlighted the importance of musical reminiscence and emotional respite, and demonstrated changes with time through the singing and songwriting group.

CONCLUSIONS & IMPLICATIONS

The benefits of offering singing/songwriting groups may be felt not only by participants with PD but also by their spouses/partners even if they choose not to attend themselves. Such benefits may include improved relationships related to the shared joy of music, musical reminiscence and emotional respite. The addition of songwriting encourages creativity and agency. A longitudinal trajectory approach is one way to appreciate how these benefits may unfold over time for participants.

WHAT THIS PAPER ADDS

What is already known on the subject Group singing for people with PD has been shown to have physical, emotional and social benefits as measured on mainly pre-post-assessments of vocal, speech, respiratory function and quality of life questionnaires. What this study adds to the existing knowledge This study adds three new aspects: studying the benefits for the couple (both people with PD and their spouse/partner); taking an in-depth focused ethnographic approach over time to collect couples' narratives and experiences; and exploring the potential for adding songwriting to the intervention. What are the potential or actual clinical implications of this work? A qualitative trajectory approach may help clinicians understand why such interventions are experienced as beneficial. Clinicians running singing groups for people with PD should offer attendance to spouses/partners because of the potential for such groups to improve relationships and build new points of connection for the couple, as well as provide peer support for spouses. Songwriting is a useful addition for creativity, cognitive flexibility and self-expression.

"Out and proud…. in all your shaking glory" the wellbeing impact of a dance program with public dance performance for people with Parkinson's disease: a qualitative study

PURPOSE

To explore if and how Parkinson's disease dance class participation and public performance contributes to perceptions of wellbeing.

MATERIALS AND METHODS

A qualitative design using audio-recorded one-on-one semi-structured interviews with five class participants and three teachers/volunteers from two metropolitan Dance for Wellbeing class locations. Data were inductively thematically analysed by three researchers.

RESULTS

Five themes illustrated the experience of dance class and performance for people with Parkinson's Disease: 1) 'the enabling learning environment'; 2) 'physical benefits from class participation; 3) 'mental/psychological benefits from class participation'; 4) 'social benefits from class participation; 5) 'sense of self and life engagement from class participation'. Themes 4 and 5 in particular were considered to be 'magnified by public performance', providing an opportunity for solidarity within the group and a supportive avenue for "coming out" and living publicly with the PD diagnosis.

CONCLUSION

Dance performance magnifies health and wellbeing experiences of people with Parkinson's disease when part of an enabling, inclusive and emotionally and physically safe learning dance class environment. Elements of holistic benefits, as well as the fun and playful nature of the experience may be important elements to consider for motivation, recruitment and retention in this population.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should consider the use of dance class as an art-based activity that has a holistic therapeutic benefit.Flexible and fun environments are constructive for dancers to sustain attendance and interest.Rehabilitation professionals can be cognisant of the impact of public dance performance as 'coming out' with Parkinson's Disease.

Community Choir Improves Vocal Production Measures in Individuals Living with Parkinson's Disease

OBJECTIVES

Parkinson's disease (PD) is a neurodegenerative disease leading to motor impairments and dystonia across diverse muscle groups including vocal muscles. The vocal production challenges associated with PD have received considerably less research attention than the primary gross motor symptoms of the disease despite having a substantial effect on quality of life. Increasingly, people living with PD are discovering group singing as an asset-based approach to community building that is purported to strengthen vocal muscles and improve vocal quality.

STUDY DESIGN/METHODS

The present study investigated the impact of community choir on vocal production in people living with PD across two sites. Prior to and immediately following a 12-week community choir at each site, vocal testing included a range of vocal-acoustic measures, including lowest and highest achievable pitch, duration of phonation, loudness, jitter, and shimmer.

RESULTS

Results showed that group singing significantly improved some, though not all, measures of vocal production. Group singing improved lowest pitch (both groups), duration (both groups), intensity (one group), and jitter (one group) and shimmer (both groups).

CONCLUSIONS

These findings support community choir as a feasible and scalable complementary approach to managing vocal production challenges associated with PD.

Lifting spirits and building community: the social, emotional and practical benefits of all-female group singing

A mixed-methods concurrent identical design was implemented to explore the following research question: what are the emotional, social, and practical impacts of group singing for women from a regeneration area? Members of an all-female community choir based in an area of disadvantage participated in a focus group and survey. The most significant quantitative finding was an increase in the overall perceived level of health, which seemed linked to qualitative themes of 'positive emotions', 'redefining and reclaiming identity', 'choir as an extended family' and 'community interaction and impact'. Three themes arose from qualitative data: social impact, health and well-being aspects, and practical issues. Integrating qualitative and quantitative findings identified an overarching concept that 'choir participation may increase emotional and social health and well-being'. Group singing was found beneficial, with a potential to serve as a resource in cultivating resilience in individuals living in areas of disadvantage.

Social withdrawal in Parkinson's disease: A scoping review

BACKGROUND

Parkinson's disease (PD) can interfere with individuals' social functioning and lead to social withdrawal. Social withdrawal may result in negative outcomes for persons with PD and their caregivers, such as decreased quality of life. It is necessary to understand the nature of social withdrawal in PD in order to develop strategies to address this issue and prevent negative outcomes.

OBJECTIVE

The purpose of this scoping review was to synthesize existing evidence regarding social withdrawal in PD.

METHODS

We searched PubMed, CINAHL, and PsycINFO for studies of social withdrawal in individuals living with PD. Findings were organized according to study characteristics, measurement and description of social withdrawal, prevalence, associated factors, and interventions.

RESULTS

Fifty-eight studies were included. We found that persons with PD reduced social activities voluntarily and involuntarily, and social withdrawal was related to various factors including physical, cognitive, and psychiatric symptoms and perceived stigma. Community-based social activity programs appeared to improve social participation. Few studies employed longitudinal methods or tested interventions to reduce social withdrawal.

CONCLUSIONS

Social withdrawal is associated with various negative outcomes in PD, though more research is needed to understand the true scope of this problem. Limitations in social withdrawal research include vague conceptualization and methodological limitations (i.e., instrumentation and study design), as well as a paucity of interventional studies. The findings of this review can be used to guide hypothesis generation and future study design, with the ultimate goal of mitigating social withdrawal and improving quality of life for people with PD.

Motivation as a Predictor of Aphasia Treatment Outcomes: A Scoping Review

PURPOSE

Motivation is a complex phenomenon that can influence a person's ability to make progress in treatment. We sought to understand how motivation is currently measured and utilized in aphasia rehabilitation by identifying treatment studies that (1) include measurement of motivation and (2) use motivation to predict treatment response.

METHOD

A scoping review was conducted by systematically searching PubMed, CINAHL, EBSCO, Ovid MEDLINE, and APA PsycInfo using the following search terms: (measurement OR treatment OR rehabilitation OR predict*) AND (motiv* OR engagement OR adherence OR compliance) AND (aphasia OR dysphasia).

RESULTS

Two studies met our inclusion criteria. Motivation was measured differently across studies. No studies used motivation to predict treatment outcomes.

DISCUSSION/CONCLUSIONS

Despite the importance of motivation in aphasia rehabilitation success, studies that include its measurement are sparse. Additional research is needed and should include development of measurement tools and evaluation of the predictive value of motivation on treatment outcomes.

Singing for the Rehabilitation of Acquired Neurogenic Communication Disorders: Continuing the Evidence Dialogue with a Survey of Current Practices in Speech-Language Pathology

Therapeutic applications of singing (e.g., melodic intonation therapy) for acquired neurogenic communication disorders (ANCD) such as post-stroke aphasia, dysarthria, or neurodegenerative diseases have emerged from innovations by clinical speech-language pathologists (SLPs). However, these specialists have never been systematically consulted about the use of singing in their practices. We report a survey of 395 SLPs in France using an online questionnaire (September 2018-January 2019). Most (98%) knew that singing could be a therapeutic tool. A wide variety of uses emerged in our data. Some practices (e.g., song games) have not yet been investigated in research settings. Melodic therapy, which is supported by scientific evidence, is familiar to clinicians (90%), but they lack training and rarely follow a full protocol. Over half of respondents (62%) recognize group singing for various benefits, but do not often use it, mainly due to the lack of adapted or welcoming choirs in their area. These results provide key information for continued dialogue between researchers, clinicians, and the community. Considering the aging population and the associated increase in the prevalence of ANCD, access to group singing in particular could be facilitated for these patients from a social prescription perspective with further research evidence.

Co-designing a remote rehabilitation tool for Parkinson's disease: exploratory values and challenges

BACKGROUND

Impaired motor function is one of the early symptoms shown in patients with Parkinson Disease (PD). For this reason, rehabilitative interventions have been used for many years to improve motor and non-motor symptoms. Among them, the use of music therapy has shown benefits in helping to overcome some of the most common motor dysfunction. Addressing the challenge of providing access to this type of therapy, this document presents the collaborative design process to develop a remote training support tool for PD based on music therapy.

METHODS

A qualitative study with creative co-design methods was used in which different groups of healthcare professionals, patients, and relatives participated in six iterative sessions. Workshops were designed and structured to incrementally discover requirements and needs and validate the proposed prototype ideas.

RESULTS

The study provided key aspects that were used for the development and validation of the proposed prototypes for the remote music-based training support tool for PD. Up to 20 factors that had a positive and/or negative influence on patient access to training were detected. These factors were classified into three common themes: daily activities and independence, participation in treatment and barriers to daily treatment, and self-management and personalization of information and telecommunication technologies (ICT).

CONCLUSIONS

This paper shows the results of a collaborative design process aimed at identifying the different factors, relevant to patients with PD, to improve their access to remote ICT-based training therapy and their expectations regarding alternative therapies, such as music. The participatory design methods and the iterative model used helped overcome many of the traditionally barriers that this type of technological support solutions usually have, facilitating the future participation.

Music Therapy and Parkinson's Disease: A Systematic Review from 2015-2020

Parkinson's disease can be approached from various points of view, one of which is music therapy-a complementary therapy to a pharmacological one. This work aims to compile the scientific evidence published in the last five years (2015-2020) on the effects of music therapy in patients with Parkinson's disease. A systematic review has been performed using the Web of Science and Scopus databases with the descriptors "music therapy" and "Parkinson's disease". A total of 281 eligible articles were identified, which, after applying the inclusion and exclusion criteria, were reduced to 58 papers. The results display a great diversity of evidence, confirming positive effects on various spheres. All mentioned patients with Parkinson's disease had experienced different music therapy programs. Some studies focused on the motor component, which can be addressed through listening, body rhythm, and rhythmic auditory stimulation. Other studies confirm effects on communication, swallowing, breathing, and the emotional aspect through programs that focus on singing, either individually or in groups, in order to improve the quality of life of people with PD. It was concluded that music therapy programs can achieve improvements in various areas of patients with Parkinson's.

Music Improves Social and Participation Outcomes for Individuals With Communication Disorders: A Systematic Review

There is increasing interest in exploring the benefits of music in rehabilitation settings. In the field of speech-language pathology, an ultimate goal for individuals with communication disorders is to foster participation across multiple contexts. The goal of this systematic review was to explore social and participation outcomes for individuals with communication disorders who received arts-based interventions. A systematic search of the literature yielded 86 studies, which were coded and summarized in terms of participants, arts-based intervention, social and participation variables, outcome, and quality of evidence. The majority of identified studies (N = 71) utilized music. Results indicated that music-based interventions can improve social and participation outcomes, such as frequency of responses, initiation of communication, turn-taking, joint attention, and group participation for children and adults with autism spectrum disorder and developmental and acquired communication disorders; however, future research is needed to expand the use of varied arts-based interventions targeting a larger breadth of social and participation outcomes.

Social Symptoms of Parkinson's Disease

Parkinson's disease (PD) is typically well recognized by its characteristic motor symptoms (e.g., bradykinesia, rigidity, and tremor). The cognitive symptoms of PD are increasingly being acknowledged by clinicians and researchers alike. However, PD also involves a host of emotional and communicative changes which can cause major disruptions to social functioning. These incude problems producing emotional facial expressions (i.e., facial masking) and emotional speech (i.e., dysarthria), as well as difficulties recognizing the verbal and nonverbal emotional cues of others. These social symptoms of PD can result in severe negative social consequences, including stigma, dehumanization, and loneliness, which might affect quality of life to an even greater extent than more well-recognized motor or cognitive symptoms. It is, therefore, imperative that researchers and clinicans become aware of these potential social symptoms and their negative effects, in order to properly investigate and manage the socioemotional aspects of PD. This narrative review provides an examination of the current research surrounding some of the most common social symptoms of PD and their related social consequences and argues that proactively and adequately addressing these issues might improve disease outcomes.

The use of music as an arts-based method in migrant health research: a scoping review protocol

There is increasing recognition that people’s lived experience needs to be incorporated into health decision-making. This has led to rising imperatives for involving the public in health processes, including research. While there have been significant advances in the field, patterns of exclusion still exist in some areas, including migrant participation in health research. Migration and mobility create challenges around social inclusion and this extends to social and cultural practices used in research. There is an emerging body of literature about improving meaningful, participatory spaces for migrants’ involvement in health research using creative tools and techniques that are attuned to cultural diversity. These include the use of arts-based research methods. There is strong evidence for the use of music, particularly singing, as an effective arts-based participatory tool . The goal of this scoping review is to investigate the evidence for the use of music as an arts-based method in migrant health research. Developed by an interdisciplinary team specialising in public and patient involvement; nursing and midwifery; primary health care; and the performing arts, it aims to analyse existing evidence across disciplines that are not usually studied together, identify gaps in current knowledge and use these as a foundation to build effective strategies towards increasing access to and knowledge of participatory, arts-based methods using music in migrant health research.

Methods: The protocol for this scoping review follows the guidelines and stages set out in the JBI Reviewer’s Manual ( Peters et al., 2017), and by Levac et al, (2010), which build on the methodological framework of Arksey and O’Malley (2005). This incorporates six stages: 1) Identifying the research question; 2) Identifying relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising, and reporting results; and 6) Consultation.

Communication research in the context of te whare tapa whā model of health

Purpose: Te whare tapa whā represents a Māori view of health and wellness in four dimensions: taha wairua (spiritual health), taha hinengaro (mental health), taha tinana (physical health) and taha whānau (family health). This model of health focuses on indigenous Māori in Aotearoa/New Zealand but has relevance for all people. Speech-language pathologists, including those not familiar with this model, recognise that all four dimensions are needed to support health and wellbeing. Taha wairua includes the importance of culture and heritage to personal identity, an area that speech-language pathology (SLP) recognises as key to clinical competency. Taha hinengaro includes the need to express thoughts and feelings, another area particularly salient to SLP. The other two dimensions taha tinana (physical health) and taha whānau (family health) are arguably more familiar in the day-to-day work of speech-language pathologists.Method: Two broad strands of research are examined within this model of health exploring the challenges faced by vulnerable populations namely: (1) two community based groups (a Choir and a Gavel Club) for people with acquired neurological conditions such as stroke and Parkinson's disease, and (2) diagnosis and management of hearing loss and auditory processing disorder.Result: Community based groups, explored through the CeleBRation Choir and the Gavel Club, highlighted the application of all aspects of te whare tapa whā to the experiences of people with neurological conditions participating in these community therapies. In the area of hearing loss and auditory processing disorder, gaps across all four dimensions of taha wairua, taha hinengaro, taha tinana and taha whānau were identified in the available literature and in examination of clinical provision for participants.Conclusion: Te whare tapa whā provides a framework to consider all the elements that contribute to people living well while experiencing communication challenges within their whānau (extended family). This approach relies on strong partnerships between clinicians, extended family, researchers, communities, organisations and other professionals. Clinicians and researchers are encouraged to consider how their beliefs, practices and impact could improve through consideration of Indigenous health models such as te whare tapa whā.

"Ode to confidence": Poetry groups for dysarthria in multiple sclerosis

Purpose: Approximately 40-50% of people with multiple sclerosis (MS) have dysarthria impacting confidence in communication. This study explored how people with MS experienced a novel therapeutic approach combining dysarthria therapy with poetry in a group format.Method: Participants were recruited through MSWA (formerly known as the Multiple Sclerosis Society of Western Australia), a leading service provider for people living with all neurological conditions in Western Australia. They attended eight weekly sessions led by a speech pathologist and a professional poet. The study was co-designed and qualitative, using observational field notes recorded during sessions and semi-structured in-depth interviews with participants after programme completion. The results from an informal, unstandardised rating scale of communication confidence, along with standardised voice and speech measures, were used to facilitate discussion about confidence in the interviews.Result: Nine participants with MS completed the group programme. Analysis of the qualitative data revealed participants' positive views regarding the pairing of speech pathology and poetry. Thematic analysis identified four core themes: living with MS and its "series of griefs"; belonging to a group - "meeting with a purpose"; the power of poetry; and poetry as a medium for speech pathology.Conclusion: Poetry in combination with dysarthria therapy represents a novel, interprofessional approach for improving communication confidence in individuals with MS.

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

A systematic review on the effects of group singing on persistent pain in people with long-term health conditions

Background and Objectives

Singing can have a range of health benefits; this paper reviews the evidence of the effects of group singing for chronic pain in people with long‐term health conditions.

Database and Data Treatment

We searched for published peer‐reviewed singing studies reporting pain measures (intensity, interference and depression) using major electronic databases (last search date 31 July 2018). After screening 123 full texts, 13 studies met the inclusion criteria: five randomized controlled trials (RCTs), seven non‐RCTs and one qualitative study. Included studies were appraised using Downs and Black and the Critical Appraisals Skills Programme quality assessments.

Results

Included studies reported differences in the type of singing intervention, long‐term condition and pain measures. Due to the high heterogeneity, we conducted a narrative review. Singing interventions were found to reduce pain intensity in most studies, but there was more equivocal support for reducing pain interference and depression. Additionally, qualitative data synthesis identified three key linked and complementary themes: physical, psychological and social benefits.

Conclusion

Group singing appears to have the potential to reduce pain intensity, pain interference and depression; however, we conclude that there is only partial support for singing on some pain outcomes based on the limited available evidence of varied quality. Given the positive findings of qualitative studies, this review recommends that practitioners are encouraged to continue this work. More studies of better quality are needed. Future studies should adopt more robust methodology and report their singing intervention in details. Group singing may be an effective and safe approach for reducing persistent pain and depression in people with long‐term health conditions.

Significance

This systematic review assesses research evidence for the effectiveness of group singing on chronic pain in people with long‐term health conditions. Narrative syntheses revealed that there is partial support for singing effects on some pain outcomes based on the limited available evidence of varied quality. Qualitative data provided additional support of physical, psychological and social benefits. The review highlights implications for practice and future studies.

Psychosocial Impact of Dysarthria: The Patient-Reported Outcome as Part of the Clinical Management

BACKGROUND

Dysarthria in neurological disorders can have psychosocial consequences. The dysarthric speaker's perspective towards the disorder's psychosocial impact is essential in its global assessment and management. For such purposes, assessment tools such as the Dysarthria Impact Profile (DIP) are indispensable.

OBJECTIVE

We aimed to confirm the relevance of using the DIP to quantify the psychosocial consequences of dysarthria in neurological diseases.

METHODS

We studied 120 participants, 15 healthy controls and 105 patients with different kinds of dysarthria induced by several neurological disorders (Parkinson's disease [PD], Huntington's disease, dystonia, cerebellar ataxia, progressive supranuclear palsy [PSP], multiple system atrophy, lateral amyotrophic sclerosis). All participants underwent a cognitive evaluation and a speech intelligibility assessment and completed three self-reported questionnaires: the 36-Item Short Form Health Survey, the Voice Handicap Index (VHI), and the DIP.

RESULTS

The psychometric properties of the DIP were confirmed, including internal consistency (α = 0.93), concurrent validity (correlation with the VHI: r = -0.77), and discriminant validity (accuracy = 0.93). Psychosocial impact of dysarthria was revealed by the DIP for all patients. Intelligibility loss was found strongly correlated with the psychosocial impact of dysarthria: for a similar level of intelligibility impairment, the DIP total score was similar regardless of the pathological group. However, our findings suggest that the psychosocial impact measured by the DIP could be partially independent from the severity of dysarthria (indirectly addressed here via speech intelligibility): the DIP was able to detect patients without any intelligibility impairment, but with a psychosocial impact.

CONCLUSIONS

All patients reported a communication complaint, attested by the DIP scores, despite the fact that not all patients, notably PD, ataxic, and PSP patients, had an intelligibility deficit. The DIP should be used in clinical practice to contribute to a holistic evaluation and management of functional communication in patients with dysarthria.

Internal cueing improves gait more than external cueing in healthy adults and people with Parkinson disease

Walking can be challenging for aging individuals and people with neurological disorders such as Parkinson disease (PD). Gait impairment characterized by reduced speed and higher variability destabilizes gait and increases the risk of falls. External auditory cueing provides an effective strategy to improve gait, as matching footfalls to rhythms typically increases gait speed and elicits larger steps, but the need to synchronize to an outside source often has a detrimental effect on gait variability. Internal cueing in the form of singing may provide an alternative to conventional gait therapy. In the present study, we compare the effects of internal and external cueing techniques on forward and backward walking for both people with PD and healthy controls. Results indicate that internal cueing was associated with improvements in gait velocity, cadence, and stride length in the backward direction, and reduced variability in both forward and backward walking. In comparison, external cueing was associated with minimal improvement in gait characteristics and a decline in gait stability. People with gait impairment due to aging or neurological decline may benefit more from internal cueing techniques such as singing as compared to external cueing techniques.

Creative Arts-Based Therapies for Stroke Survivors: A Qualitative Systematic Review

Background: Stroke is a life-threating cerebrovascular disease. Without proper and immediate treatment, it can cause long-term disabilities and even death. While current rehabilitation focuses on functional needs, it does not fully address the psychosocial issues. Creative arts-based therapies, however, may have the potential to be of assistance.

Methods: A systematic review was conducted to synthesize the qualitative findings of the stroke survivors' positive and negative experiences in participating in creative arts-based therapies. A systematic literature search was conducted across diverse databases. A thematic synthesis was adopted to analyze the results from different qualitative studies and mix-method studies.

Results: Among the 367 studies extracted from various databases, 11 studies met the inclusion criteria and were of acceptable quality. The following five analytical themes were identified: functional restoration, psychological support, social engagement, spiritual experience, and short-comings and barriers.

Conclusion: Creative arts-based therapies have demonstrated their strengths in addressing psychosocial needs for stroke survivors. Different art modalities are perceived to be useful in achieving different therapeutic goals. Therapies based on a single art modality or combined modalities have different specialties and characteristics. Further research is needed to demonstrate the differential benefits or special advantages of using single or multiple art modalities as well as having qualified therapists in creative arts-based therapies.

Golden oldies and silver brains: Deficits, preservation, learning, and rehabilitation effects of music in ageing-related neurological disorders

During the last decades, there have been major advances in mapping the brain regions that underlie our ability to perceive, experience, and produce music and how musical training can shape the structure and function of the brain. This progress has fueled and renewed clinical interest towards uncovering the neural basis for the impaired or preserved processing of music in different neurological disorders and how music-based interventions can be used in their rehabilitation and care. This article reviews our contribution to and the state-of-the-art of this field. We will provide a short overview outlining the key brain networks that participate in the processing of music and singing in the healthy brain and then present recent findings on the following key music-related research topics in neurological disorders: (i) the neural architecture underlying deficient processing of music (amusia), (ii) the preservation of singing in aphasia and music-evoked emotions and memories in Alzheimer's disease, (iii) the mnemonic impact of songs as a verbal learning tool, and (iv) the cognitive, emotional, and neural efficacy of music-based interventions and activities in the rehabilitation and care of major ageing-related neurological illnesses (stroke, Alzheimer's disease, and Parkinson's disease).

Patient reported experiences of using community rehabilitation and/or support services whilst living with a long-term neurological condition: a qualitative systematic review and meta-aggregation

Objectives: The objective of this study is to identify patient reported experiences of using community rehabilitation and/or support services whilst living with a long-term neurological condition, and perceptions of their impact on quality of life.Methods: Nine electronic databases were searched for peer-reviewed qualitative studies from 2005 to 2016, which met the inclusion criteria. Critical appraisal, data extraction, and quality assessment of 37 included papers were performed by three reviewers. One hundred and one findings were extracted. Meta-aggregation was used to synthesize findings.Findings: Seven 'synthesized findings' [SF] were produced: Interactions with some professionals provide active participation, choice, confidence and autonomy [SF1]; Interactions with some professionals are disempowering and depersonalized [SF2]; Effective communication, specialist knowledge and an individualized approach to information provision is needed [SF3]; Indicators of success vary and may not be clear [SF4]; Informal support from family/friends is valued [SF5]; Opportunities for peer support/social interaction is valued [SF6]; Coordination required to ensure continuity during transition to community [SF7].Conclusion: Patient reported experiences identified common factors associated with process quality (respect, choice, autonomy, information provision, communication) and activities of patient centered care (personalized care, shared decision-making, self-management support) despite heterogeneity of neurological conditions, service configurations, and geographical location. These factors impact quality of life.Implications for RehabilitationPatient reported experiences provide useful information about courtesy, respect, choice, autonomy, information provision, and communication.Outcomes of self-efficacy and self-management are important for people with stable and progressive long-term neurological conditions.Interactions with individual professionals influence engagement, self-efficacy, and self-management for people with long-term neurological conditions.Training for health and social care professionals should develop the advanced communication skills and behavior required to facilitate self-efficacy and self-management.

Music therapy applied to complex blast injury in interdisciplinary care: a case report

Purpose: Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member. Methods: Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members. Results: In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team. Conclusions: Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community. Implications for Rehabilitation Music therapy in stand-alone sessions and in co-treatment with traditional disciplines can enhance treatment outcomes in functional domains of motor, speech, cognition, social integration, and quality of life for military populations. Music therapists can help ease discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care. Music therapy assists treatment processes from clinic to community, making it highly valued by the patient, family, and interdisciplinary team members in military healthcare. Music therapy provides a platform to prevent social isolation by promoting community integration through music performance.

Experiences of Persons With Parkinson's Disease Engaged in Group Therapeutic Singing

Background

Parkinson's disease (PD) is a progressive neurodegenerative disorder that leads to altered neural control of movement, including the control of voice, respiration, and swallowing. There is a prevalent need to provide therapy for voice, respiration, and swallowing difficulties because current pharmacological and surgical treatments do not effectively treat these impairments. Previous research has demonstrated that singing may be a treatment option to target voice, respiratory, and swallowing impairments, as well as quality of life. However, participants' perspectives related to reasons for enrolling and engaging in programs as well as evaluation of singing programs have been neglected.

Objective

The purpose of this descriptive study was thus to solicit participants' views of their involvement in a group singing intervention (GSI) led by credentialed music therapists.

Methods

Twenty persons with PD were interviewed 4 to 6 months after completing the singing intervention. Participants were asked about 1) why they chose to participate, 2) what were the beneficial and non-beneficial aspects of participating, and 3) how to improve overall design and delivery of the GSI.

Results

Using content analysis procedures, we learned that participants regarded their involvement in the study as mutually beneficial, fun, and engaging. Participants appreciated the fellowship with other persons with PD and offered minimal constructive criticism.

Conclusions

This study provided greater insight into how a therapeutic singing program may benefit participants and positively impact their lives.

Music for the ageing brain: Cognitive, emotional, social, and neural benefits of musical leisure activities in stroke and dementia

Music engages an extensive network of auditory, cognitive, motor, and emotional processing regions in the brain. Coupled with the fact that the emotional and cognitive impact of music is often well preserved in ageing and dementia, music is a powerful tool in the care and rehabilitation of many ageing-related neurological diseases. In addition to formal music therapy, there has been a growing interest in self- or caregiver-implemented musical leisure activities or hobbies as a widely applicable means to support psychological wellbeing in ageing and in neurological rehabilitation. This article reviews the currently existing evidence on the cognitive, emotional, and neural benefits of musical leisure activities in normal ageing as well as in the rehabilitation and care of two of the most common and ageing-related neurological diseases: stroke and dementia.

The role of music therapy in rehabilitation: improving aphasia and beyond

Music is part of the human nature, and it is also philogenically relevant to language evolution. Language and music are bound together in the enhancement of important social functions, such as communication, cooperation and social cohesion. In the last few years, there has been growing evidence that music and music therapy may improve communication skills (but not only) in different neurological disorders. One of the plausible reasons concerning the rational use of sound and music in neurorehabilitation is the possibility to stimulate brain areas involved in emotional processing and motor control, such as the fronto-parietal network. In this narrative review, we are going to describe the role of music therapy in improving aphasia and other neurological disorders, underlying the reasons why this tool could be effective in rehabilitative settings, especially in individuals affected by stroke.

Cognitive, emotional, and neural benefits of musical leisure activities in aging and neurological rehabilitation: A critical review

Music has the capacity to engage auditory, cognitive, motor, and emotional functions across cortical and subcortical brain regions and is relatively preserved in aging and dementia. Thus, music is a promising tool in the rehabilitation of aging-related neurological illnesses, such as stroke and Alzheimer disease. As the population ages and the incidence and prevalence of these illnesses rapidly increases, music-based interventions that are enjoyable and effective in the everyday care of the patients are needed. In addition to formal music therapy, musical leisure activities, such as music listening and singing, which patients can do on their own or with a caregiver, are a promising way to support psychological well-being during aging and in neurological rehabilitation. This review article provides an overview of current evidence on the cognitive, emotional, and neural effects of musical leisure activities both during normal aging and in the rehabilitation and care of stroke patients and people with dementia.

An investigation of the psychometric properties of the Chinese (Cantonese) version of Subjective Index of Physical and Social Outcome (SIPSO)

OBJECTIVE

The objectives of this study were 1) to translate and make cultural adaptations to the English version of the SIPSO questionnaire to create a Chinese (Cantonese) version, 2) evaluate the internal consistency, test-retest reliability the C-SIPSO questionnaire, and 3) compare the SIPSO-C scores of stroke survivors with different demographic characteristics to establish the discriminant validity of the questionnaire Design: Translation of questionnaire, cross sectional study.

SETTING

University-based clinical research laboratory. Subjects Community-dwelling chronic stroke survivors.

INTERVENTIONS

Not applicable.

MAIN MEASURES

Subjective Index of Physical and Social Outcome, Geriatric Depression Scale, 10-metre Walk test.

RESULTS

Two bilingual professional translators translated the SIPSO questionnaire independently. An expert panel comprising five registered physiotherapists verified the content validity of the final version (C-SIPSO). C-SIPSO demonstrated good internal consistency (Cronbach's α = 0.83) and excellent test-retest reliability (ICC_3,1 = 0.866) in ninety-two community dwelling chronic stroke survivors. Stroke survivors scored higher than 10 in the Geriatric Depression Scale ( U = 555.0, P < 0.001) and with the comfortable walking speed lower than 0.8ms^-1 ( U = 726.5; P = 0.012) scored significantly lower on SIPSO-C.

CONCLUSION

SIPSO-C is a reliable instrument that can be used to measure the level of community integration in community-dwelling stroke survivors in Hong Kong and southern China. Stroke survivors who were at high risk of minor depression and with limited community ambulation ability demonstrated a lower level of community integration as measured with SIPSO-C.