Singing with neurology in mind

“I have known instances in which the characteristics of both conditions existed concurrently in the same individual.” The Duchess of Plaza-Toro in The Gondoliers (W.S.Gilbert, Act II)


The Duchess was speaking of marriage, of course, and how it produced in men the unlikely effect of being both married and single at the same time. She could have been talking about singing, where many elements co-exist within the one activity. Singing, with its ability to encode multiple messages simultaneously, is an important tool in the field of music therapy. This is especially important in neurological disorders such as Parkinson’s Disease (PD) where multi-tasking is compromised. Studies by Pacchetti (2000) and Elegant (2012) have confirmed music’s importance in treatment programmes and advocated its regular use. In singing, various musical elements such as melodic patterning, rhythm, attack and length of musical gesture, and text, are present concurrently. A single musical task, then, can challenge the musical maker to integrate several elements. Each one can influence breathing, articulation, physical character, facial expression and emotional temperament.

Significantly, this can all be achieved through group singing, a highly social and entertaining activity. This article reflects on the experience of building a simple programme of teaching in order to deliver various experiences through song.

When I first began to teach singing to people living with PD (in Perth, Western Australia), my own symptoms of the disease had been variously diagnosed and at that stage were thought to be benign essential tremor. So for the design of my musical programme I took my cues from my singers – they were the people who knew best their symptoms, their limitations and their preferences. However, as my own condition progressed I was able to factor in personal observation. This practice of self-reflection encouraged me to view elements of singing as treatment for components of the illness. Essentially, I changed the sessions from being explicitly about social engagement and community development into sessions that implicitly targeted symptoms. I was able to achieve this through four main areas of singing: breathing; articulation; rhythm; and text.

Breathing

The rigidity of muscle movement associated with PD oftentimes inhibits some physical functionality such as breath control. This can be addressed in singing, either through the use of exercises or in song.

The simpler the breathing exercise, the more likely the chances of achieving engagement from a group of non-singers. Counting one to 20 on a single breath can waken conscious thought of breath control. Adding variations such as “legato” or “staccato” or “accent the odd numbers” can stimulate interest in the exercise (we preferred to think of them as “games”), and increasing the count up to 25, and then 30 offers new challenges and stirs conscious thought for extended breathing

The choice of song material unconsciously calls the singer’s attention to deeper, more sustained breathing. Songs from the “standards” songbooks proved to be invaluable: not only did they have the advantage of being memorable and, most likely, familiar, they were constructed from long-phrases and held notes. The songs of Jerome Kern (Smoke Gets In Your Eyes) and Cole Porter (Begin The Beguine) are examples.

SMOKE GETS IN YOUR EYES – PERFORMED BY JUDY GARLAND

Articulation and facial expression
To address the issue of masking – a condition where the facial muscles are less active than before and not as responsive, typically producing a mask-like, impassivity of the face – music again allows its performers to engage in therapeutic exercise subconsciously. Singing, with its exaggeration of the biomechanics of vocal production, can challenge the singer to keep the facial muscles active and lively. Ballads with extended vowel sounds (The Way We Were) or lively patter songs that encourage rapid change of consonant values (Oom pah pah) produce strong results.

To address the issue of masking – a condition where the facial muscles are less active than before and not as responsive, typically producing a mask-like, impassivity of the face – music again allows its performers to engage in therapeutic exercise subconsciously. Singing, with its exaggeration of the biomechanics of vocal production, can challenge the singer to keep the facial muscles active and lively. Ballads with extended vowel sounds (The Way We Were) or lively patter songs that encourage rapid change of consonant values (Oom pah pah) produce strong results.

THE WAY WE WERE – BARBRA STREISAND

By paying attention to terminal-consonants, double-consonants or inner sounds, song allows the singer to exercise elements of speech in a subliminal fashion. Songs like the Hatch and Trent Downtown are filled with phrases that, patter-like, must be offered up with a sense of relish if the singer is not to trip over the musical material. This is even more critical in A Day Trip to Bangor, a nonsense song with the chief musical delight of challenging the singer’s verbal dexterity. John Denver’s rural anthem Take Me Home, Country Roads contains many phrases which conclude with a hard consonant giving the novice singer a chance to enjoy the emphatic ending to musical and lyrical phrases.

Additionally, tongue-twisting phrases can be of benefit when spoken in a group setting. For example, Lapine and Sondheim’s Into the Woods is littered with hard-edged aphorisms – “No knot unties itself”, “The slotted spoon can catch the potato”. They tease the ear, trip the tongue, and tickle mental acuity with a sense of fun.

Rhythm

For people with PD the simple task of tapping in rhythm to a song is made difficult because of the tremors and bradykinesia. I once asked my class to clap along as they sang a simple 4/4 marching song. It was kindly pointed out to me that “we don’t do multitasking”. Although the brain responds well to musical signals it was necessary to distinguish between singing skills and rhythmic skills, and we never tried to combine the two again.

Despite the arrhythmic tendencies brought on by neurological disorders, music can stimulate an all-of-body response. People feel the impulse to dance and will pursue it even though the body is not able to respond in ways it used to. Many times, when I was robust enough to lend support, singers would rise from their chairs and meet me in the middle of the practice space – both men and women – eager to dance again, to liberate the locked body. It was always a privilege and a delight to me, and I would include old-fashioned danceable songs to encourage this. We never tried group movement activities as the desire for movement seemed to be personal and spontaneous.

Nevertheless participants knew that they were welcome to dance if the moment presented itself.

Language/meaning/emotional content

The story goes that Mrs Hammerstein II and Mrs Kern were present together at a party. A guest approached Mrs Kern and cooed “Oh, yes, your husband wrote Ol’ Man River”. “Correction”, said Mrs Hammerstein II. “Her husband wrote dum-dum-dee-dum. It was my husband who wrote Ol’ Man River”.

If song contains the power to move us, to inspire and transform us, it is in part due to its lyrical qualities. The text of a song adds specificity to the musical gesture, and this invites self-reflection.

However, as with any art, a cursory glance may be all that is granted of a lyric, and even a good lyric may be relegated to the status of cliché. And that is why, with my father’s intrigue for words and my own innate penchant for meaning – “what’s it really about?” – I would include songs to promote group discussion. The conversations might range across the various techniques of lyricists, especially the techniques at play in any given song (I’m old fashioned and if a rhyme is not a true rhyme it’s probably a consonance – let’s talk about what that is), through to a song’s inner meaning. By looking at the text of a song, we were ready to give colour to words, shape to phrase, interpretation to song. The Beatles, of course, are perfect for this kind of discussion, and Dylan, Cohen and other poet-songwriters post-1960. But the Broadway lyricists are of immense value too – Hammerstein, Sondheim, Alan Jay Lerner – with their smart wordplay, attitudes of romance and ambivalence, and knowledge of how to fashion words to music. The important thing was to have conversation at a group level. Music links directly to nostalgia and to other important periods of personal development such as socialisation; this can give rise to an opening up of discussion on an individual’s past and their development, further forging the bonds within the group.

Singing together is an ancient art; it’s also modern medicine. While I have outlined some of the means through which to help those with PD achieve a state of improved health, there is one more benefit, and that belongs to the conductor: the gift of humility. The singers must be allowed to express their gratitude to their musical director.

Time and again my singers have rewarded me well beyond the usual means. And if, for a moment, I stop listening to the music – that endlessly fascinating thing that runs rampant in my mind, with all its rich possibilities and thread of connections – if I let go of the music and hold the thought of the group, I hear their deep gratitude and their joy for music. And I am humbled, and for a moment, I am healed. A concluding song, such as Gilpin’s massively popular anthem to the power of music, Why We Sing, might even give pause to the Duchess of Plaza-Toro and help her believe that wholeness in an individual is readily achievable.


Brian Dawson has forged twin careers as a performer and a music librarian/researcher. He has sung, danced, directed, acted and choreographed his way through a selection of great works for the musical stage, has written two musicals and numerous art-songs with composer/collaborator Ziggy de Voight. In the past ten years he has taught ensemble singing to people with special needs such as those living with Parkinson’s disease and seniors in rural Western Australia. At the same time he forged a 20 year career as a music librarian, also serving for some time as Director of the State Reference Library in Western Australia. He was engaged in archival work and study towards a Doctor of Philosophy degree at the University of Western Australia (researching the stage musicals of Peter Stone) when he was diagnosed with Parkinson’s at the age of 50. In 2016, together with ensemble Close Harmony Choir he presented an experiment in poetry and a cappella singing titled Adventures of a Poet which played to two sell-out houses and raised funds for Parkinson’s WA. Among his current projects is the creation of a poetic extension of C.S. Lewis The Chronicles of Narnia. rmb52b@gmail.com


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