Music Therapy Protocol to Support Bulbar and Respiratory Functions in ALS
The study directed by Alisa Apreleva, MT-BC, NMT, at Cambridge Institute for Music Therapy Research (Cambridge, UK) in collaboration with ALS Centre Moscow (Moscow, Russia), evaluates the potential of music therapy treatment to support breathing, speech, swallow and cough of persons with amyotrophic lateral sclerosis (ALS).
Trial registration NCT03604822 – click on the link for the detailed description of the study.
Study aim and significance
This study intends to determine feasibility of a music therapy protocol as intervention to support respiration, cough, swallowing and speech functions of persons with amyotrophic lateral sclerosis. Since music therapy constitutes a new treatment modality for bulbar and respiratory dysfunction in ALS, the study is focused primarily on safety and tolerability of the treatment protocol.
Applied music therapy research in multidisciplinary clinical context allows to systematically look at bulbar and respiratory functions support in ALS, which is important to do, since swallowing, vocalization and breathing are tightly coordinated, and close relationship exists between these processes, in terms of location and activation of the neurons (Larson, Yajima et al., 1994), (Matsuo, 2008).
Music therapy treatment protocol
Upper motor neurons and lower motor neurons deterioration in ALS results in dysarthria and dysphagia of spastic-flaccid type, although actual presentation varies in each patient and changes with the disease progression. Generally, lower motor neurone (LMN) involvement, characteristic of bulbar onset, leads to flaccid presentation, whilst degeneration of upper motor neurone (UMN), characteristic of spinal onset, results in spasticity of bulbar muscles. Muscle relaxation and moderate exercise, as well as learning efficient breathing and voice production techniques, voice care techniques and ALS-specific communication strategies may be helpful, rather than rigorous strengthening oral motor exercises. The protocol serves the following primary therapy objectives:
- to increase breath support,
- to increase muscle relaxation,
- to increase speech rate,
- to prevent / decrease hypernasality,
- to maintain swallowing coordination.
ALS-specific, individualized MT protocol was delivered to study participants in their homes twice weekly for the duration of six weeks by the researcher, who is a board certified music therapist and neurologic music therapist, with experience of working with this patient group and in this setting. Facilitating music structures have been composed by the researcher to support cueing, timing and intensity of breathing and vocalization exercises. These structures were regularly modified to suit the unique capabilities, current individual demands and progress of each participant.