The Voice That Moves You
Voice Aerobics® has always been built on a whole-body approach to voice practice — the understanding that the voice does not exist in isolation, but is connected to breath, posture, energy, and spirit. Self-vocalization as a movement tool is perhaps the clearest expression of that philosophy.
“One, two, three, four…”
You have heard it at the gym. You have heard it in an exercise class. Counting out loud — a small, seemingly simple act. But for a person living with Parkinson’s disease, that voice counting out loud, is a simple movement that may be doing far more than keeping time.
It may be helping the brain move the body.
Why Movement Becomes Difficult in Parkinson’s
Parkinson’s disease disrupts the basal ganglia — the brain’s internal timing system. This is the region responsible for the smooth, automatic regulation of movement. When dopamine-producing neurons in the basal ganglia begin to degenerate, movement loses its internal rhythm. Walking slows. Steps become shuffled. Initiating movement can feel like pushing through mud, and freezing episodes may occur without warning, and voice itself, often become soft in volume (hypophonia).
What we have come to understand over decades of research is that when the brain’s internal cue system breaks down, external cues can step in to restore function. Auditory rhythmic stimulation — the use of sound, beat, or rhythm as a movement cue — has been one of the most reliably studied tools in Parkinson’s rehabilitation. Metronomes, music, and clapping all show measurable benefit for gait, stride length, and cadence. [1]
But here is the question that interests me most as an SLP: What happens when the cue comes from inside — from the person’s own voice?
Your own voice may be one of the most powerful movement cues available — and it is always with you.
Self-Vocalization: What It Is and Why It Matters
Self-vocalization is the act of using one’s own voice — counting aloud, chanting, singing, or rhythmic speech — to cue or drive physical movement. Unlike an external metronome or music played through a speaker, the person with Parkinson’s generates the auditory rhythm themselves.
This is not a new idea. Physical therapists have long observed that persons with Parkinson (PWP) who count aloud during exercise tend to perform movements with greater consistency and amplitude. Occupational therapists report that patients who verbalize their actions step, step, step navigate transfers and doorways more confidently. And in my own clinical practice over thirty years, I have observed that patients who vocalize using voice at target loudness during voice practice show improvements not just in their speech, but in their posture, breath support, and whole-body engagement.
So what is happening in the brain when you use your own voice to drive your body?
The Auditory-Motor Connection: A Two-Way Street
The brain areas responsible for processing rhythm overlap substantially with those that control motor function — including the supplementary motor cortex, the premotor cortex, the cerebellum, and yes, the basal ganglia themselves. [2] Rhythm, whether heard or self-generated, activates this auditory-motor coupling.
Interestingly, recent neuroimaging research has found that both external auditory cues (like music or a metronome) and internal, self-generated cues (like mental singing or counting aloud) activate overlapping brain pathways — including motor and sensory areas — with each offering slightly different engagement of neural circuits. External cues activate the auditory cortex more strongly, while self-generated cues tend to engage the cerebellum and involve greater attentional resources. [3]
This means that when a person with Parkinson’s counts aloud during movement, they are not merely keeping track. They are actively generating a rhythmic auditory signal that couples with the motor system and may help compensate for faulty internal timing from basal ganglia degeneration.
For persons with freezing of gait (FOG), one of the most disabling and dangerous Parkinson’s symptoms, research suggests that auditory cueing can trigger neuroplastic changes in the motor cortex that are not observed with self-paced, un-cued movement. [5] When the internal timer falters, an external or self-generated rhythmic signal may unlock movement in ways that medication alone cannot.
Practical Applications: How to Use Your Voice to Power Movement
The beautiful thing about self-vocalization is that it requires no equipment, no subscription, and no special setting. It is a whole-body practice which the Voice Aerobics® program was built on, and when coupled with a Hi-VOLT® voice-on-light (a voice activated feedback tool) even activities of daily living can be an opportunity for targeted voice practice strengthening your voice and your movement simultaneously. Here are some simple, practical strategies:
- Count aloud during exercise repetitions. When you lift, stretch, or step, wear your Hi-VOLT bracelet for feedback and count out loud: “ONE, TWO, THREE, FOUR.” Use a strong voice — not a whisper. Speak Loud Enough to Activate the Light.The volume matters both for your voice practice and for maximizing the cueing effect.
- Chant a rhythm during walking. Simple phrases like “LEFT, right, LEFT, right” or “step it UP, step it UP” can help organize your gait. Choose a phrase with a natural beat that matches your target walking pace.
- Sing through transitions. Initiating movement — standing from a chair, beginning to walk — is often the hardest moment. Try humming or singing a familiar song with a strong beat as you prepare to move. The rhythmic signal may help the motor system “get the green light.” In a strong voice say “UP” as you rise from a chair.
- Use a Hi-VOLT® during speech therapy practice, physical and occupational therapy, and Boxing class. These are are an ideal time to combine strong, intentional vocalization with movement. Reach, push, lift — and let your voice lead the way.
Your voice is not just for communication. It is a cue. It is a rhythm. It is a signal your brain and body can follow. So the next time you exercise, take a walk, or simply rise from your chair — let your voice lead the way. Speak strong. Move strong. One, two, three, four.
A Note for Carepartners
If you support someone living with Parkinson’s, you can play a meaningful role in this practice. Counting aloud together, chanting during a walk, or singing alongside your person during exercise is not silly — it is supported by science, and it can make the experience enjoyable for both of you. Movement done with voice and with connection is better than movement done in silence and isolation.
Clinical Takeaway for SLP Colleagues
- Self-vocalization engages auditory-motor coupling pathways that overlap with and may partially compensate for basal ganglia timing deficits in PD.
- Consider integrating voice-cued movement (counting, chanting, rhythmic speech) into voice practice sessions as a dual-domain intervention targeting both communication and mobility.
- Coordinate with physical and occupational therapy colleagues to encourage carryover of vocal self-cueing and speech practice during gait and ADL training.
- Document observations of how loudness, voice onset, and breath support respond during movement-combined practice; these data strengthen the case for interdisciplinary referral and treatment planning.
Want to Learn More? Visit Parkinson Wellness Recovery
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
Voice Aerobics the heART and Science of Voice Practice
References
[1] Ghai, S., Ghai, I., Schmitz, G., & Effenberg, A. O. (2018). Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis. Scientific Reports, 8, 506.
[2] Grahn, J. A., & Rowe, J. B. (2009). Feeling the beat: Premotor and striatal interactions in musicians and nonmusicians during beat perception. Journal of Neuroscience, 29(23), 7540–7548.
[3] Harrison, E. C., et al. (2025). Neural mechanisms underlying synchronization of movement to musical cues in Parkinson disease and aging. Frontiers in Neuroscience.
[4] Cochen De Cock, V., et al. (2018). Individualization of music-based rhythmic auditory cueing in Parkinson’s disease. Research Gate / Frontiers in Neurology.
[5] Thaut, M. H., et al. (1996). Rhythmic auditory stimulation in gait training for Parkinson’s disease patients. Movement Disorders, 11(2), 193–200.