A patient with Parkinson disease asked why some people with Parkinson’s disease (PD) have difficulty speaking and yet, may be able to sing with relative clarity. A similar phenomena I have observed with some individuals with PD who walk hesitantly and carefully with a cane, and then glide smoothly and cofidently on a dance floor. When it comes to speech and singing, I hypothesize that one reason is the difference in areas of the brain that control motor speech and those that control musicality and singing. In previous blog posts, I have discussed the difference between reading out loud or reciting rote phrases and contrasting it to conversational speech with its complexity of listening, processing information and formulating novel thoughts. The phrasing and melody of a song may help those who have difficulty with managing breath support when speaking and the words of a song are readily available unlike the novel thoughts we must formulate during conversation.
A research publication in the Journal of Speech and Hearing Research reported results of a study in which investigators examined the difference between singing and speech in individuals with Parkinson’s disease and cerebellar disease CD.[i] Both diagnoses often cause motor speech symptoms, but the symptoms are typically different in each disease, and in fact, a speech-language pathologist’s clinical findings can often help neurologists in the differential diagnosis of a disease.
Hypophonia (low volume) is the most characteristic feature of PD speech while excessive variation of loudness, often with imprecise articulation is more a feature of CD speech. Prior research and clinical practice have revealed that persons with PD often respond positively to an external cue with an increase in volume and clarity. In contrast, CD speech can be described as similar to intoxicated speech with variable pitch and imprecise articulation and is less amiable to external cues. These differences in the motor speech patterns between the two groups and the response differences to singing and speech cues suggests that different regions of the brain are activated when speaking and singing.
Recent studies using brain imaging techniques suggest that the cerebellum may be important for some aspects of vocal motor control required in singing, supporting the hypothesis that different levels of vocal demands are associated with talking and singing. Singing, where the linguistic information (the lyrics) and music are integrated into one performance, may require a different level or type of motor control and coordination than that which is typically required for speech.
Future research which includes brain imaging will no doubt help us better understand these nuances, and guide clinicians and researchers as we translate these findings into clinical practice.
If you are someone with Parkinson’s, what is the take-home message?
If you have difficult communicating in every- day situations because your speech lacks volume or clarity it’s imperative that you work with a speech-language pathologist who can recommend the best treatment approach for your symptoms and meet with you periodically as motor speech symptoms change due to disease progression. If you enjoy singing, then by all means participate in a choral singing group and enjoy the benefit you will likely receive emotionally and physically.
And singing doesn’t have to be just for the person with PD, in fact, it can be a great activity to share with your spouse or a friend. A systematic review published in 2024 provides evidence for evaluating the effects of singing as an intervention for aging voice and concluded that while additional research is warranted, singing as an intervention for older adults with respiratory and cognitive problems could improve respiration and respiratory–phonatory control. And, it’s just FUN!
[i] Singing and Speaking Ability in Parkinson’s Disease and Spinocerebellar Ataxia Yoonji Kim, Diana Sidtis, and John J. https://doi.org/10.1044/2022_JSLHR-22-00274
ii Systematic Review: Singing-Based Interventions to Improve Physical Functions Related to Aging Voice in Older Adults Journal of Speech, Language, and Hearing Research Volume 67, Number 7 Pages 2139-2158 https://doi.org/10.1044/2024_JSLHR-23-00641[1]
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My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Certified End of Life Specialist (CEOLS) * Voice Aerobics® A Whole Body Approach to Voice Practice