How can singing in a choir help people with Parkinson's Disease?
The Chris Davis Choir, run by the Hornsby/Ku-Ring-Gai Parkinson’s Association Inc, conducted by Dr Naomi Cooper
Parkinson’s disease and its impacts on the voice
While estimates are difficult due to the absence of an accurate diagnosis tool, resulting in under-diagnosis and misdiagnosis, around 70,000-80,000 people in Australia have Parkinson’s (Deloitte Access Economics, 2015, pp. 17–23).
Parkinson's is an “incurable, progressive, debilitating neurological disorder” (Forbes, 2021, p. 1199) where many parts of the body are affected, including the voice. Each individual's symptoms are different and can vary day-to-day, however, approximately 90% of people with Parkinson's Disease develop dysarthria, “a disorder of spoken communication due to central or peripheral nervous system damage that is associated with disturbance in muscular control for speech,” in the course of the disease (Tjaden, 2008, p. 115). Parkinson’s disease “can be associated with speech deterioration and low communication confidence which in turn compromises social interaction.” (Tamplin et al., 2021, p. 1).
People with Parkinson’s often experience changes to their spoken voice as one of their earliest symptoms, including:
changes to speech articulation;
loss of perceived vocal volume;
hoarseness, breathiness or weakness in the voice;
reduced spoken pitch range and variation;
prosodic disturbance;
voice tremor; and
difficulty initiating the voice
(Miller, 2012, p. 2).
There are several factors that contribute to these vocal challenges, including:
reduced muscular control of the respiratory and laryngeal mechanisms that are responsible for vocal production;
an impairment in auditory perception (where the individual has difficulty judging how loud or soft they are speaking, meaning individuals often think they are speaking loudly when they in fact are not); and
a perceived sense of high vocal effort
(Miller, 2012, pp. 2–3).
Specific speech therapy strategies have been developed to address these challenges, such as the Lee Silverman Voice Treatment (LSVT Global, 2022). Singing, especially in a group designed for people with Parkinson’s, can support these speech therapy activities, and can provide additional benefits as well.
Singing for health and wellbeing
In recent decades, extensive research has demonstrated the benefits of singing for health and wellbeing of all people including positive impacts on physical health and mental health outcomes (Clift et al., 2017; Grape et al., 2003; Williams et al., 2018). Group singing has been found to have additional benefits (Beck et al., 2000; Clift, 2010; Kreutz et al., 2004; Livesey et al., 2012; Williams et al., 2018), particularly related to social outcomes and wellbeing.
Research is now focusing on the health and wellbeing benefits of group singing for particular purposes and demographics, for example, older people (Davidson et al., 2014), stroke survivors (Tamplin et al., 2013), people affected by cancer (Reagon et al., 2017) and COPD patients (Bonilha et al., 2009).
The Chris Davis Choir performing at ABC Sing Out Sydney, conducted by Dr Naomi Cooper
Singing for people with Parkinson’s disease
Singing, particularly in a group, can be helpful for people with Parkinson’s for a number of reasons, including improving vocal function, improving social outcomes, cognitive engagement, and having a positive effect on mental health.
Singing essentially involves an extension of the muscular control and co-ordination that is required for speech, including both the respiratory muscles (used for breathing), and laryngeal muscles (used for vocal production). It is therefore unsurprising that these muscle groups are strengthened and conditioned when we sing. Recent research has revealed benefits of group singing for people with Parkinson’s, including improvements in bradykinesia (slow movement), facial masking, breathing, speech and singing (Di Benedetto et al., 2009; Elefant et al., 2012; Evans et al., 2012; Fogg-Rogers et al., 2016; Pacchetti et al., 2000)
Research has investigated the use of auditory cues, including music, to alleviate gait disturbances (Braunlich et al., 2019; Ford et al., 2010; Rodger & Craig, 2016) and has found that pleasurable music is particularly effective (Park et al., 2020). It has also been suggested that singing may contribute to prosodic improvement, as study participants did not experience the same prosodic impairment in singing as they did in speech (Harris et al., 2016).
Singing in a group can also have a positive effect on mental health outcomes. A recent international study of people with Parkinson’s demonstrated that group singing can “reduce stigma, anxiety and stress and enhance social support in older adults living with Parkinson’s” (Irons et al., 2021, p. 650).
One study investigating the impact of group singing on quality of life for people with Parkinson’s reported on social benefits of participating in a Parkinson’s choir, such as forming new friendships, sharing a sense of community and camaraderie (Abell et al., 2017). This holds particular significance, as many people with Parkinson’s withdraw from social situations or feel isolated because of challenges they experience with communication or other symptoms that make it difficult to attend events and participate in society. Participants also reported improvements in cognitive functioning.
Carer wellbeing
While singing in a choir can have positive outcomes for people with Parkinson’s, participating in a choir has also been found to be a positive experience for carers, particularly spouse caregivers. In a recent study, “findings demonstrated that group singing created a social identity which helped fulfill caregivers’ basic psychological needs for belonging, meaning and purpose, social support, and agency within the marital relationship. Caregivers’ new and valued social identity helped counteract the diminishing effects of life impacted by Parkinson’s. These findings support the recognition and further understanding of group singing as an accessible and cost-effective community-based psychosocial intervention for Parkinson’s spouse caregivers” (Forbes, 2021, p. 1199).
Join a Parkinson’s Choir
Named after one of the choir's founding members, who championed the benefits of singing in a choir for people with Parkinson's Disease, The Chris Davis Choir is run by the Hornsby Ku-ring-gai Parkinson's Association Inc. It is a wonderful community where I lead the group in vocal exercises and singing specifically aimed at addressing the vocal needs of people with Parkinson's, informed by the latest research. We also share morning tea, a laugh and good company.
We meet Thursday mornings 10am-11:30am at Turramurra Senior Citizen's Centre.
If you or a loved one is living with Parkinson's and would like to join the choir, send me a message and I will send you all the info. The choir also welcomes members of the public who like to sing, so you don't need to have Parkinson's to join.
The association is a registered charity. If you'd like to support the Hornsby Ku-ring-gai Parkinson's Association's work (they also hold a support group and exercise class specifically for people with Parkinson's).
References
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Beck, R. J., Cesario, T. C., Yousefi, A., & Enamoto, H. (2000). Choral Singing, Performance Perception, and Immune System Changes in Salivary Immunoglobulin A and Cortisol . In Music perception (Vol. 18, Issue 1, pp. 87–106). University of California Press . https://doi.org/10.2307/40285902
Bonilha, A. G., Onofre, F., Vieira, M. L., Almeida Prado, M. Y., & Martinez, J. A. B. (2009). Effects of singing classes on pulmonary function and quality of life of COPD patients . In International journal of chronic obstructive pulmonary disease (Vol. 4, Issue 1, pp. 1–8). Dove Medical Press . https://go.exlibris.link/4J672bRw
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