Amyotrophic lateral sclerosis (ALS) is a rapidly progressive, fatal neurodegenerative disease involving primarily motor neurons in the cerebral cortex, brainstem and spinal cord (Brooks et al, 2000). Most people with ALS develop dysarthria, dyspnoea, and dysphagia as a result of progressive weakness of lips, tongue, soft palate, pharynx, larynx and diaphragm muscles.
Music therapy is clinical, evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship. Music therapy was found to be beneficial for psychological wellbeing (Davies et al., 2016) and decreasing perception of physical symptoms of the disease (Raglio et al., 2016) in people with ALS. Few studies have assessed the effectiveness of NMT protocols to treat dysarthria, dysphagia and dyspnea (Tamplin, 2008), (Kim, 2010), (Azekawa and Blythe Lagasse, 2017). The effectiveness of music therapy in this context is based on the following:
- close relationship exists between swallowing, vocalization and breathing, in terms of location and activation of the neurons (Larson, Yajima et al., 1994),
- rhythmic entrainment primes motor neurons for action (Thaut, 2013),
- musical rhythm serves as a pacemaker when entrainment occurs with subject’s breathing patterns (Kim, 2010),
- patients motivation to work towards therapeutic goals increases with use of music (Thaut and Hoemberg, 2016).
Neurologic music therapy (NMT) is the therapeutic application of music to cognitive, sensory, and motor dysfunctions that come from human neurologic diseases. NMT treatment is based on stimulating music perception and production parts in the human brain, and the effects thereof on nonmusical and behavior functions (Thaut, 2016).
Oral Motor and Respiratory Exercises (OMREX) utilize structured sound vocalization and wind instrument(s) playing in order to enhance articulatory control, respiratory strength and function of speech apparatus (Hass and Distenfeld, 1986), (Thaut, 2005);
Therapeutic Singing (TS) involves use of singing activities to facilitate initiation, development and articulation in speech, and to increase functions of the respiratory apparatus (Thaut, 2005);
Rhythmic Speech Cuing (RSC) uses rhythmic cueing to prime speech patterns or pace the rate of speech, and can cue muscular coordination for dysarthria (Thaut, 2005).
Although there is a reported lack of evidence supporting the use of strengthening exercises for improving speech in patients with ALS (Hanson, Yorkston, Britton, 2011), there is no evidence of such exercises being harmful. Emerging studies from speech therapy and physical therapy (Pinto, Swash and de Carvalho, 2012), (Plowman et al., 2016), (Tabor et al., 2016) suggest that respiratory training may have positive effect on respiratory and swallowing functions in people with ALS.
If you are looking to learn more about music therapy applications for people affected by ALS and their caregivers, consider visiting this page.
“Yoga, meditation and breathing exercises support the diaphragm and should be included as a daily regimen for breath control and awareness. Using extra pillows under the head, neck and back when sleeping or lying down can be helpful. It’s important to rest between daily activities to reduce shortness of breath. Try to take 5 to 10 deep breaths to fully expand the lungs several times a day, holding your breath, then exhaling through pursed lips. If you enjoy singing or playing a wind instrument, all the better”
The following presentation on music therapy for ALS treatment took place in Moscow, Russia, at the Third Annual Patients’ Conference organized by ALS Foundation Live Now in February 2017 (in Russian, no subtitles). Download our brief Music Therapy for PALS and CALS guide (in English).