A Music Therapy Treatment Protocol for Acquired Dysarthria Rehabilitation

Abstract

ABSTRACT: Dysarthria is a common form of speech impairment, affecting 20-50% of stroke patients and 10-60% of traumatic brain injury patients (Sellers, Hughes, & Langhorne, 2002). Very little research has been conducted on the effect of treatments for dysarthria and even less has been reported on rehabilitative music therapy interventions. In the current climate of evidence-based practice (Edwards, 2002) the music therapy profession needs to develop and rigorously test interventions designed to address specific disorders such as dysarthria. This paper discusses theoretical foundations for the use of singing interventions to treat dysarthria and presents a music therapy dysarthria treatment protocol incorporating vocal and respiratory exercises and therapeutic singing. Publications on the use of music therapy in neurorehabilitation have increased considerably in recent years. However, a recent review of this literature (Gilbertson, 2004) found mainly descriptions of clinical approaches and treatment practices in neurorehabilitation with little outcome-based evidence for treatment. Limitations reported in this review include inconsistencies or omissions in recording neurodiagnostics, applications of other concurrent therapies, assessment tools used, and time elapsed between injury and therapeutic music intervention (Gilbertson, 2004). So far, only a small body of music therapy research exists in the area of communication rehabilitation. Preliminary findings have indicated that music therapy techniques, such as singing and vocal training, can assist in rehabilitation of communication disorders (Adamek, Gervin, & Shiraishi, 2000; Cohen, 1992); however, further research on particular music therapy interventions to address specific communication disorders is needed. The purpose of this paper is to present and discuss a music therapy protocol to treat the various symptoms of acquired dysarthria, including intelligibility, rate of speech, communication efficiency, fluency and naturalness. The findings of case study research assessing the efficacy of this protocol are published elsewhere in greater detail (Tamplin, 2008). It is important to understand the neurophysical factors of dysarthria that inform music therapy intervention and influence treatment outcomes. These will also influence clinical decisions such as the choice of musical material used, the selection of appropriate music therapy techniques, the length and frequency of intervention, and the method of evaluation chosen. Dysarthria Dysarthria refers to a group of motor speech disorders involving disturbances in control of the speech musculature as a result of nervous system damage (Abbs & De Paul, 1989). There is a particularly high incidence of dysarthria following acquired brain injury as dysarthria may result from damage to a number of areas in the brain including the upper or lower motor neuron system, the cerebellum, the extrapyramidal system or a combination of these (Sarno, Buonaguro, & Levita, 1986; Sellars et al., 2002). Clinical presentation may include impairments in the movement and coordination of speech musculature in terms of strength and tone, and impairments in range, timing, speed and steadiness of movement (Darley, Aronson, & Brown, 1975). In particular, dysarthria is often characterized by reduced verbal intelligibility, voice volume or range, abnormal rate of speech, and poor prosody, which in combination often impair speech naturalness. The sequelae of dysarthria and its neurological foundations distinguish it from other neurological speech and language disorders such as apraxia and aphasia. These higher-level representational communication disorders are associated with temporal lobe lesions in the language dominant hemisphere. Aphasia is a neurological language processing disorder involving difficulty formulating and/or interpreting words and sentences (Brookshire, 2003). Apraxia is primarily a motor planning problem and not a problem with the muscles themselves; thus, the apraxic speakers' articulation and prosody are abnormal, but phonation and resonance are usually unaffected (Brookshire, 2003). …