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Neuroscience
The Music-Speech-Rehab Connection
How singing can help re-wire our brains for speech
Posted April 15, 2011
Ever since the horrific events that occured in Tucson last January, many have been following the recovery process of Rep. Gabrielle Giffords. Her therapy process has garnered national--even international--attention. It was featured on an Anderson Cooper 360 segment by Dr. Sanjay Gupta. It was written up by the BBC. Hey...even I wrote about it!
One of the therapies Rep. Giffords has been receiving that we've been hearing and reading about is music therapy. The early media reports mentioned how, through music therapy, she had been singing "Twinkle, Twinkle Little Star" and "Happy Birthday." Many people may have read that and thought "How nice." But there's more to the concept than the nostalgia of singing familiar children's songs.
Singing is a powerful way to help re-wire the brain to re-learn how to speak.
The Research
A 2006 study by Ozdemir, Norton, and Schlaug investigated just this. While connected to an fMRI machine, ten right-handed participants were asked to repeat two-syllable words or phrases, some intoned ("sung") and some non-intoned ("spoken"). There were two additional tasks designed to control for other variables associated with vocalizing: a humming condition to help control for pitch and a condition to help control for the oral-motor process.
The brain scans showed similar areas on both sides of the brain (primarily in the motor production and sensory feedback areas) that were activated by both the sung and spoken conditions. Additionally, the researchers noted that singing activated the right hemisphere in some areas more strongly than the left (and remember that speech is a left-hemisphere-dominate function).
In other words, similar networks in the brain associated with vocal production are activated when a person is singing and when s/he is speaking. And the "stronger right hemisphere" activation provides support for the clinical observation that those who cannot speak because of damage to the left hemisphere speech areas (known as Broca's area) can still produce words by singing them.
Clinical Implications
As mentioned above, the Ozdemir, Norton, and Schlaug study supports what speech and music therapists have observed about those with damage to Broca's area--their ability to speak words is impaired, but their ability to sing words is intact.
Music therapists (and speech therapists with some musical training) can use this in a powerful way to help those who've had a stroke, a Traumatic Brain Injury, or some other neurological insult that impairs Broca's area. We can use singing to help re-wire the brain to speak. Our clients may not be able to regain all their former speaking abilities...but even regaining some functional speech can make a big difference.
Although the treatment process varies based on the client's individual needs, it may start with trying to solicit spontaneous speech--which is likely what the TIRR music therapist was doing when she sang "Twinkle, Twinkle" and "Happy Birthday." These are highly familiar songs to many people. And I would bet that when you hear "Twinkle, twinkle little..." you want to fill in "star." Spontaneously.
Eventually, the therapist may create a melody for a phrase that would help the client communicate something purposeful and functional, such as "I am hungry." In therapy-ese, we call this using "functional speech." Our musical skills come into play, because there are certain ways we can compose the pitch and rhythm of the melody to mirror typical speech patterns.
The next step of "patient training" may follow the protocol (or at least a modified protocol) for the Melodic Intonation Therapy technique developed in the 1970s by speech therapists. This protocol involves a series of training and practice steps that lead the patient from singing the phrase with the therapist to singing the phrase alone to speaking the phrase.
Although I don't know specifics about Rep. Gifford's therapy (and nor should I. I'm not her therapist!), I do know how to use music to help with speech rehab efforts. And I know that it can work in a powerful way.
If you're interested in learning more about how music therapy can support therapeutic goals addressing speech, language, and communication, please visit the American Music Therapy Association at www.musictherapy.org.
Follow me on Twitter @KimberlySMoore for daily updates on the latest research and articles related to music, music therapy, and music and the brain. I invite you also to check out my website, www.MusicTherapyMaven.com, for additional information, resources, and strategies.
References
Ozdemir, E., Norton, A., & Schlaug, G. (2006). Shared and distinct neural correlates of singing and speaking. NeuroImage, 33(2), 628-35.
Sparks, R.W. & Deck, J.W. (1994). Melodic intonation therapy. In R. Chaper (Ed.), Language Intervention Strategies in Adult Aphaia, 368-386. Baltimore: Williams & Wilkins.
Sparks, R.W., Helm, N., & Albert M. (1974). Aphasia rehabilitation resulting from melodic intonation therapy. Cortex, 10, 313-316.
