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A Music Therapy Treatment Protocol for Acquired Dysarthria Rehabilitation

Article  in  Music Therapy Perspectives · January 2008

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A Music Therapy Treatment Protocol for Acquired
Dysarthria Rehabilitation
JEANETTE TAMPLIN
DENISE GROCKE
ABSTRACT: Dysarthria is a common form of speech impairment,
affecting 20–50% of stroke patients and 10–60% of traumatic brain
injury patients (Sellars, Hughes, & Langhorne, 2002). Very little re-
search has been conducted on the effect of treatments for dysarthria
and even less has been reported on rehabilitative music therapy in-
terventions. In the current climate of evidence-based practice (Ed-
wards, 2002) the music therapy profession needs to develop and rig-
orously test interventions designed to address specific disorders such
as dysarthria. This paper discusses theoretical foundations for the use
of singing interventions to treat dysarthria and presents a music ther-
apy dysarthria treatment protocol incorporating vocal and respiratory
exercises and therapeutic singing.
Publications on the use of music therapy in neurorehabili-
tation have increased considerably in recent years. However,
a recent review of this literature (Gilbertson, 2004) found
mainly descriptions of clinical approaches and treatment
practices in neurorehabilitation with little outcome-based ev-
idence for treatment. Limitations reported in this review in-
clude inconsistencies or omissions in recording neurodiagnos-
tics, applications of other concurrent therapies, assessment
tools used, and time elapsed between injury and therapeutic
music intervention (Gilbertson, 2004).
So far, only a small body of music therapy research exists
in the area of communication rehabilitation. Preliminary find-
ings have indicated that music therapy techniques, such as
singing and vocal training, can assist in rehabilitation of com-
munication disorders (Adamek, Gervin, & Shiraishi, 2000; Co-
hen, 1992); however, further research on particular music
therapy interventions to address specific communication dis-
orders is needed.
The purpose of this paper is to present and discuss a music
therapy protocol to treat the various symptoms of acquired
dysarthria, including intelligibility, rate of speech, communi-
cation efficiency, fluency and naturalness. The findings of case
study research assessing the efficacy of this protocol are pub-
lished elsewhere in greater detail (Tamplin, in press). It is im-
portant to understand the neurophysical factors of dysarthria
that inform music therapy intervention and influence treat-
Jeanette Tamplin, M.M., RMT, is a music therapist at the Royal Talbot Reha-
bilitation Centre in Melbourne, Australia. The article is based on her Master’s
research completed at the University of Melbourne. She is the co-author of
Music therapy methods in neurorehabilitation: A clinician’s manual.
Denise Grocke, Ph.D., RMT, FAMI, MT-BC, is an associate professor and head
of music therapy at the University of Melbourne where she is also director
of the National Music Therapy Research Unit. She is the co-author of Recep-
tive methods in music therapy.
 2008, by the American Music Therapy Association
PAGE 23 File # 03em
pg 23 # 1
Royal Talbot Rehabilitation Centre, Austin Health, Melbourne, Australia
University of Melbourne, Australia
ment outcomes. These will also influence clinical decisions
such as the choice of musical material used, the selection of
appropriate music therapy techniques, the length and fre-
quency of intervention, and the method of evaluation chosen.
The purpose of this paper is to present and discuss
a music therapy protocol to treat the various symp-
toms of acquired dysarthria, including intelligibility,
rate of speech, communication efficiency, fluency
and naturalness.
Dysarthria
Dysarthria refers to a group of motor speech disorders in-
volving disturbances in control of the speech musculature as
a result of nervous system damage (Abbs & De Paul, 1989).
There is a particularly high incidence of dysarthria following
acquired brain injury as dysarthria may result from damage to
a number of areas in the brain including the upper or lower
motor neuron system, the cerebellum, the extrapyramidal sys-
tem or a combination of these (Sarno, Buonaguro, & Levita,
1986; Sellars et al., 2002). Clinical presentation may include
impairments in the movement and coordination of speech
musculature in terms of strength and tone, and impairments
in range, timing, speed and steadiness of movement (Darley,
Aronson, & Brown, 1975). In particular, dysarthria is often
characterized by reduced verbal intelligibility, voice volume
or range, abnormal rate of speech, and poor prosody, which
in combination often impair speech naturalness.
The sequelae of dysarthria and its neurological foundations
distinguish it from other neurological speech and language
disorders such as apraxia and aphasia. These higher-level rep-
resentational communication disorders are associated with
temporal lobe lesions in the language dominant hemisphere.
Aphasia is a neurological language processing disorder in-
volving difficulty formulating and/or interpreting words and
sentences (Brookshire, 2003). Apraxia is primarily a motor
planning problem and not a problem with the muscles them-
selves; thus, the apraxic speakers’ articulation and prosody are
abnormal, but phonation and resonance are usually unaffect-
ed (Brookshire, 2003). The articulatory inconsistency in aprax-
ic speech is seen through correct articulation of phonemes at
one time and incorrect articulation of the same phonemes at
another time (Darley et al., 1975).
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In spite of the prevalence of dysarthria, little research exists
into clinical treatment for this disorder (Kent, 1994; Pilon, Mc-
Intosh, & Thaut, 1998). A systematic Cochrane review of re-
search into the effects of speech and language therapy for
dysarthria due to non-progressive brain damage found no con-
trolled trials, which is a requirement for a Cochrane review
(Sellars et al., 2002), indicating a need for more well-designed
research studies.
Music Therapy and Speech Disorders
Cohen’s (1992, 1994, 1995) seminal body of research in-
vestigating the effect of singing instruction on people with
neurogenic communication disorders in the late eighties and
early nineties has made a significant contribution to our un-
derstanding of the therapeutic effects of these techniques. Sub-
sequent research has expanded on these findings. In summary,
results of music therapy singing interventions have included
improvements in vocal range, intensity, rate, intelligibility, in-
tonation, and reduction in pause time (Adamek et al., 2000;
Baker & Wigram, 2004; Cohen, 1994, 1995; Cohen & Masse,
1993; Haneishi, 2001). However, as these studies do not dif-
ferentiate between types of communication disorders in the
inclusion criteria, it is difficult to explain a treatment effect
that is relevant to a particular neurological condition or
speech disorder. Early publications described music therapy
interventions without reporting treatment outcomes (Lucia,
1987) or claimed positive effects of singing for communica-
tion without research evidence or description of techniques
used (Claeys, Miller, Dallow-Rampersad, & Kollar, 1989).
Neural mechanisms used for motor speech, such as use of
the respiratory muscles and articulators, are shared by both
singing and speech, as are many other elements including
rhythm, pitch, dynamics, tempo, and diction. Through singing,
it is possible to address a range of factors that may affect
speech production, including rate of speech, articulation,
breath control, and prosody. As the melodic line of a song
often contains a greater number and range of vocal frequen-
cies than a spoken phrase, singing may help to change or
increase the range of pitches available to a person with limited
or abnormal vocal range (Cohen, 1994) or increase respiratory
capacity, control, and vocal intensity (Livingston, 1996). Like-
wise, rate of speech may be addressed through modifying tem-
po when singing songs (Cohen, 1988).
Theoretical Foundations for the Use of Music Therapy in
Dysarthria Rehabilitation
The rationale for music therapy treatment for dysarthria is
supported by biomedical theories suggesting that neurophys-
iological processes may be activated through musical stimu-
lation and used to effect non-musical behaviour (Taylor, 1997;
Thaut, 2000). Growing evidence suggests that considerable
cortical reorganisation is possible following neurological trau-
ma (Kolb & Gibb, 1999; Mateer & Kerns, 2000), where parts
of the brain may take over the function of other damaged parts
of the brain. It has been argued, however, that changes in the
cortex are driven by the activation of new motor skills not
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Music Therapy Perspectives (2008), Vol. 26
simply by motor use (Mateer & Kerns, 2000; Nudo, Barbay,
& Kleim, 2000). Music therapy provides a varied range of ther-
apeutic activities for activating motor skills that may assist pa-
tients to develop these neural interconnections (Baker & Roth,
2004). To increase strength of the articulator muscles, stimu-
lation of movement at appropriate velocity with correct move-
ment patterns and with sufficient contraction to engender neu-
ral adaptation is necessary (Van der Merwe, 1997). By moving
the articulators through a variety of movements that mimic
speech, it may be possible to create neural adaptation nec-
essary to strengthen dynamic articulator muscle activity.
Rhythm and Cortical and Physiological Function
Rhythm is processed diffusely in the brain and does not
depend on any single motor modality (i.e., rhythm can be
produced by hands, feet, head, body, or voice); therefore,
even severe neurological damage does not completely impair
rhythmic processing (Sacks, 1998; Thaut, 2003). The relation-
ship between the neural processing of rhythmic auditory stim-
ulation and cortical arousal of the motor system has been
demonstrated in numerous studies (Thaut, 2005a). In partic-
ular, rhythmic auditory stimulation has been shown to stimu-
late the motor system and facilitate improved movement ef-
ficiency in terms of organization and timing of muscle move-
ments for people with neurological damage (McIntosh, Thaut,
Rice, & Prassas, 1995; Thaut, McIntosh, Prassas, & Rice,
1993). As dysarthria is a motor speech disorder, it is suggested
that rhythmic cuing can stimulate and organise movement of
the speech musculature. Research supports the use of rhyth-
mic cues to control rate as well as facilitate initiation of
speech for dysarthric speakers (Hammen, Yorkston, & Minifie,
1994; Yorkston, Hammen, Beukelman, & Traynor, 1990). Sing-
ing often replicates natural speech rhythms. For people with
a neurological communication disorder, rhythm in a musical
or song context may be easier to imitate and maintain than
the rhythm of isolated speech.
Singing, Respiration and Physiological Function
During controlled breathing (e.g., during singing), the cortex
takes over direct control of the respiratory muscles by imposing
timing priorities on the pace and strength of contractions. In ad-
dition, the intratracheal pressure during singing is approximately
4 times greater than that during normal conversation (Livingston,
1996). Therapeutic singing exercises can, therefore, assist patients
to develop muscle control, expand lung capacity, and increase
vocal intensity. Patients are also able to organize their breathing
and phonation to the rhythmic structure of the music and, thus,
participate for longer periods before fatiguing. By practicing the
distribution of breath when singing a musical phrase, patients
may increase respiratory capacity.
Singing familiar songs is also a motivating way to practice
articulation, phonation, and voice projection. The act of singing
promotes active movement of the facial muscles and articulators
that may assist articulation as well as facilitate the improvement
of non-verbal aspects of communication (Haneishi, 2001). Pa-
tients with diminished muscular control may benefit from vocal
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Music Therapy Dysarthria Treatment Protocol
exercises that emphasize consonant articulation and a variety of
consonant–vowel combinations. Abnormal stress patterns com-
mon in dysarthric speech may be due to poor loudness and
frequency variation and durational adjustments. Normal stress
patterns are incorporated into song lyrics in the form of rhythm,
melody, and meter and can be used in therapy to facilitate im-
provements in speech naturalness (Tamplin, 2005).
A Music Therapy Treatment Protocol for Dysarthria
Based on the foundation of previous research (Brookshire,
2003; Darley et al., 1975; Rosenbek & LaPointe, 1985; York-
ston, 1996; Yorkston & Beukelman, 1981) and clinical expe-
rience in this area, a music therapy protocol was designed to
treat dysarthric speech. The protocol involved 24 individual
music therapy sessions over 8 weeks. Previous research has
highlighted the efficacy of frequent sessions over a short pe-
riod of time (Cohen, 1992; Darrow & Cohen, 1991; Darrow
& Starmer, 1986). Individual treatment was chosen rather than
group treatment to allow the use of patient-preferred music to
form the basis of the singing intervention. The presenting fea-
tures of dysarthria may differ between patients and between
different dysarthria types. Therefore, individual treatment ses-
sions allowed the clinician to identify specific problem areas
and progress at an appropriate pace for each patient, focusing
on areas of difficulty within the treatment protocol.
As fatigue is a significant issue for people with neurological
damage (Fletcher, 1992; Kennedy, Pring, & Fawcus, 1993),
session length was carefully considered when designing the
protocol and 30 minutes was deemed as appropriate. Previous
research suggests that patients with acquired brain injury re-
port increased fatigue and perform more poorly after 40–50
minutes of music therapy intervention (Baker, 2004).
The treatment protocol was designed to holistically address
all aspects of motor speech affected by dysarthria, including
respiration, phonation, articulation, resonance, and prosody.
Vocal exercises included physical preparation, oral motor re-
spiratory exercises, rhythmic and melodic articulation exer-
cises, rhythmic speech cuing and vocal intonation therapy
(see Appendix A) and took approximately 20 minutes to com-
plete. These exercises were designed to develop control and
strength in the muscles and mechanisms used for speech and
were kept short and varied to minimize fatigue and maximize
concentration and participation. Following these exercises,
patients sang three familiar songs together with the music ther-
apy clinician. The patients were encouraged to incorporate
strategies to improve intelligibility that had been practiced in
the preceding exercises into their singing. Therapeutic tech-
niques to maximize performance such as feedback, encour-
agement, prompting, and modeling were employed where ap-
propriate. The music therapy clinician provided guitar accom-
paniment for the songs and as much or as little vocal support
as deemed appropriate for each patient.
The frequency of sessions in clinical practice is significant.
In clinical situations where multiple sessions per week are
impractical, the use of a practice CD with exercises for the
patient to use between sessions may be beneficial. Obviously
File # 03em
pg 25 # 3
25
live music therapy intervention is preferable so that the exer-
cises can be adapted to suit the changing needs of individual
patients. However, in the real world, a practice CD developed
by the music therapist may be needed to supplement music
therapy sessions.
Preparation Exercises
It is important that the client is relaxed before beginning fo-
cused voice and speech exercises. Preparation exercises were,
thus, considered important and were conducted at the start of
each session. These exercises focused on body awareness, gen-
eral muscular relaxation, and warm-up exercises for the muscles
to be used in the remainder of each treatment session (see Ap-
pendix A). By gently stretching the neck, jaw, and tongue mus-
cles and encouraging diaphragmatic breathing, these preparation
exercises aimed to help reduce tension and move focus away
from the larynx to the respiratory system.
Oral Motor and Respiratory Exercises
Oral motor and respiratory exercises (Thaut, 2005a, 2005b)
aimed to develop breath control and increase respiratory ca-
pacity. By facilitating the exchange of greater volumes of air
during the respiratory cycle, the breathing rate is reduced, thus
allowing a longer expiratory phase. Increased breath control
allows the patient to have better control of the expiratory pul-
monary pulses that represent the driving force required for
sustained vocal fold vibration (Kotby, 1995). Gentle phonation
and humming exercises were included to facilitate decreased
tension in the laryngeal areas. The vocal cords barely adduct
during humming (Yiu & Ho, 2002), so this is an appropriate
gentle warm-up for the vocal cords. The alternation between
sustained unvoiced and voiced audible exhalations (e.g.,
shhhhhhhh and ahhhhhhhh) aimed to develop increased lung
capacity and muscular control. Pulsed exhalations (e.g., sh-
sh-sh-sh) were included to develop the intercostal muscles
used in diaphragmatic breathing (see Appendix A). With better
control of expiratory air, more appropriate timing between ex-
halation and onset of phonation is facilitated (Kotby, 1995). In
addition, greater breath control can assist the patient to
achieve an appropriate range of pitch variation.
Rhythmic Articulation Exercises
In order to build on respiratory control and strength, rhyth-
mic articulation exercises also included strong rhythmic pulse
cues to structure vocalizations. Rhythmic chanting of vowel
sounds focused particularly on vocal fold movement and co-
ordination between expiration and onset of phonation (e.g.,
i—eeee . . . i—eeee . . . i—eee . . . ). As dysarthria is often
characterized by slurred-sounding speech, efficient vocal fold
closure is necessary to facilitate clear cessation of phonation.
Melodic Articulation Exercises
Melodic exercises using vowel-consonant blends were in-
troduced in order of articulatory difficulty (see Appendix A).
These assisted articulation by practicing positioning of the
speech apparatus and promoting active movement of the fa-
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cial muscles and articulators. The melodic component of these
articulation exercises was considered important to extend
pitch range and control and, thus, improve the monotone
quality of speech that is a common feature of dysarthria.
Rhythmic Speech Cuing
Rhythmic Speech Cuing (RSC) is based on research suggesting
that rhythm stimulates arousal of the motor speech system and
organizes motor behaviour. In this protocol, RSC involved the
use of strong rhythmic pulse and emphasis of natural speech
rhythms to cue more normative speech patterns. The rhythmic
cues were provided at an appropriate rate for each patient, but
the use of rhythm to create stress was a stronger focus than rate
control. RSC exercises were based on contrastive stress drills (Ro-
senbek & LaPointe, 1985) and involved rhythmic chanting of the
same sentence in different ways. The clinician provided a strong,
consistent rhythmic pulse and modeled the sentences with em-
phasized use of rhythm, stressing a different word on each sen-
tence repetition (e.g., Week 1—I don’t know, I don’t know, I
don’t know and Week 8—I can’t believe you said that, I can’t
believe you said that, I can’t believe you said that, I can’t believe
you said that, I can’t believe you said that, I can’t believe you
said that). The use of a constant pulse with these chanted sen-
tences means that the strong beat falls on a different word with
each repetition (sometimes necessitating an anacrusis) and a
change in the rhythm of the words.
Vocal Intonation Therapy
Research has suggested that the use of melodic contours
reflecting the prosodic elements of natural speech may facil-
itate more appropriate vocal intonation (Baker, 2004; Cohen,
1994). In this protocol, vocal intonation therapy involved sung
phrases similar to melodic intonation therapy sentences but
was used to address different goals. Sentences were set to
music using the principles of melodic intonation therapy,
where the melody, rhythm, meter, and accents of the music
phrase reflect the inflection, rhythm, and stress of natural
speech prosody (see Appendix B). The exercises aimed to in-
corporate goals from each of the preceding exercises (e.g.,
expanding respiratory control, improving vocal intensity and
pitch range, incorporating rhythm to structure normal stress
patterns, and practicing articulation). The exercises involved
sung sentences that increase gradually in length (e.g., A wood-
en table. They used a wooden table. They used a wooden table
with four chairs.), and sentences that practice a particular pho-
neme repeatedly (e.g., The jug of juice was just made).
Therapeutic Singing
Therapeutic singing incorporates components of each of the
preceding exercises simultaneously to reinforce therapeutic goals
through the creation of a musical product. It utilizes the often
pleasurable and motivating qualities of singing songs to facilitate
and guide improved speech production. In addition, the use of
familiar and preferred songs often facilitates automatic genera-
tion of words and melody and reduces the need for cognitive
involvement (Prior, Kinsella, & Giese, 1990; Samson & Zatorre,
File # 03em
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Music Therapy Perspectives (2008), Vol. 26
1992). Therapeutic singing can be used to build muscle strength
through neural adaptation as the movements involved closely
match the target movements for speech in direction, force, range
and velocity (Van der Merwe, 1997). Based on principles of neu-
roplasticity, therapeutic singing may facilitate the learning of new
motor control patterns and encourage the development of syn-
aptic interconnections that influence recovery.
Song Criteria for Dysarthria Rehabilitation
Characteristics of songs useful for therapeutic singing with
dysarthric patients include slow tempo, appropriate phrase
lengths for individual patients, and appropriate key to facili-
tate maximum pitch range of individual patients. Criteria for
inappropriate songs included complex lyrics or rhythmic pat-
terns, wide pitch range, difficult melodic lines, fast tempo
(avoid rap genre or fast-paced R&B music), and negative lyr-
ical content. The decision to use patient-preferred songs was
based on literature that suggests that patients with neurologi-
cal damage respond well to familiar music as it increases en-
gagement and motivates participation (Baker, 2000, 2004;
Kennelly, Hamilton, & Cross, 2001; Thaut, 2005a). Consider-
ation of lyrical content was also incorporated into the song
selection process as Baker (2004) stated that lyrical themes,
together with musical characteristics, which express negative
emotions may facilitate an increase in the intensity of these
emotions experienced by patients. Where possible, songs
without negative emotional content were used to avoid raising
difficult emotional issues.
Songs with short phrase lengths are best initially for patients
with poor respiratory capacity. For example, ‘‘Hey Jude . . .
don’t make it bad . . . take a sad song . . . and make it better’’
(The Beatles), or ‘‘When you’re weary . . . feeling small . . .
when tears are in . . . your eyes . . . . I’ll dry them all’’ (Simon
& Garfunkle). When the patient was comfortably accomplish-
ing one phrase group per breath, attention was focused on
increasing the length of phonation of words at the ends of
phrases (i.e., extending the last word of each phrase above for
three beats). Later, as they improved, the tempo of the song
was increased and/or patients were encouraged to attempt
two phrases per breath group. For example, in the song, ‘‘Love
Me Tender’’ by Elvis Presley, the first line of the song is ‘‘love
me tender, love me true.’’ Initially only the first phrase may
be achieved on a single breath, but later in the treatment, both
phrases may be sung on a single breath. This overt initial focus
on the respiratory components of song singing was intentional
as respiration forms the basis of all other components of
speech and song. Without enough breath support to sustain
phonation for short phrases, it is not possible to address artic-
ulation, resonance, or prosody.
The key of each song was transposed to best match the pitch
range achievable for individual patients. Where necessary the
attention of the patient was drawn to the melodic line and
verbal cues for achieving improved pitch accuracy and range
were provided. In situations where the lyrical line was slightly
more complex or wordy, the patient was instructed to focus
on the rhythm of the words in order to improve articulatory
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Music Therapy Dysarthria Treatment Protocol
accuracy. For example, the main line of the chorus in The
Beatles’ song, ‘‘With a Little Help from My Friends,’’ involves
rapid tongue movement to achieve the words ‘‘with a little
help’’ quickly.
For a patient with poor respiratory capacity, songs with
shorter phrase lengths (3–4 syllables) and opportunities for
more regular breaths without disruption of the rhythmic pulse
of the song are appropriate (e.g., ‘‘what . . . would you do
. . . if I sang . . . out of tune . . . ’’ [The Beatles]). For a patient
with good respiratory capacity but with poor respiratory con-
trol, rate control, and articulation, appropriate songs may have
longer phrase lengths (up to 10 syllables). For example in the
song, ‘‘Like a Rollin’ Thunder Chasing the Wind’’ (Live), focus
should be placed on the stressed words in each phrase, using
the rhythm of the music to clearly separate the words (i.e.,
. . . like a /rollin’ /thunder /chasing the wind/).
Overuse of the same songs may reduce the therapeutic ef-
fect of the intervention. The introduction of new songs gives
patients an opportunity to practice different speech rhythms
and melodic lines in a new musical context. However, to ob-
tain maximum therapeutic benefit, patients must be given
enough time with each song to feel comfortable singing it and
then be able to focus on strategies for improving speech.
The careful selection of songs for treatment and the in-
formed use of rhythm, melody and stress to reflect natural
speech prosody when implementing vocal exercises are of vi-
tal importance to the success of these interventions. Exercises
or songs that are too difficult, in terms of pitch, tempo, or
lyrical complexity may impede patient progress and poten-
tially decrease motivation for music therapy.
Summary and Conclusions
This paper has outlined a music therapy protocol for the treat-
ment of acquired dysarthria. A clear rationale based on existing
research has been provided for the inclusion of each component
of the treatment protocol presented. Singing is a motivating ther-
apeutic medium for patients in neurorehabilitation. Singing ex-
ercises may bypass the conscious thought processes involved in
more cognitive, traditional speech therapy interventions often
used in dysarthria rehabilitation. Clinicians may also expect
greater fluency and enhanced spontaneity in speech production
when using musical exercises. It is anticipated that the devel-
opment of this dysarthria treatment protocol will provide in-
formed treatment options for music therapists to use in clinical
practice and also stimulate further research in this area.
Singing is a motivating therapeutic medium for pa-
tients in neurorehabilitation. Singing exercises may
bypass the conscious thought processes involved in
more cognitive, traditional speech therapy interven-
tions often used in dysarthria rehabilitation.
PAGE 27 File # 03em
pg 27 # 5
27
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28 Music Therapy Perspectives (2008), Vol. 26

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the rehabilitation of clients with acquired brain injury. Australasian Journal of
Neuroscience, 9(1), 12–14. Preparation Exercises (each twice)
Lucia, C. M. (1987). Towards developing a model of music therapy intervention in
the rehabilitation of head injured clients. Music Therapy Perspectives, 4, 34– 1. Close eyes and feel support of chair
37. 2. Inhale deeply and then exhale from diaphragm
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then release
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tation, 9(2), 131. face is facing ceiling
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recovery after stroke. In H. S. Levin & J. Graffman (Eds.), Cerebral reorganisation 6. Slowly turn head to left as far as comfortable
of function after stroke (pp. 168–200). New York: Oxford University Press.
7. Slowly move right ear towards right shoulder
Pilon, M. A., McIntosh, K. W., & Thaut, M. H. (1998). Auditory vs visual speech
timing cues as external rate control to enhance verbal intelligibility in mixed
8. Slowly move left ear towards left shoulder
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Prior, M., Kinsella, G., & Giese, J. (1990). Assessment of musical processing in brain- 10. Rotate jaw one way 3 times then the other way
damaged patients: Implications for laterality of music. Journal of Clinical and 11. Poke tongue out then move it up, down and side to side
Experimental Psychology, 12(2), 301–312.
12. Inhale deeply again and then exhale from diaphragm
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Oral Motor and Respiratory Exercises (each twice)
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Samson, S., & Zatorre, R. J. (1992). Learning and retention of melodic and verbal
2. Inhale deeply and exhale in shorter, controlled bursts
information after unilateral temporal lobectomy. Neuropsychologia, 30(9), 815– (‘ha-ha-ha-ha-ha’)
826. 3. Inhale deeply and exhale on ‘‘shhhhhh’’
Sarno, M., Buonaguro, A., & Levita, E. (1986). Characteristics of verbal impairment 4. Inhale deeply and exhale in shorter, controlled bursts (‘sh-
in closed head injured patients. Archives of Physical Medicine and Rehabilita-
sh-sh-sh-sh’)
tion, 67, 400–405.
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5. Inhale deeply and hum gently on exhalation
dysarthria due to non-progressive brain damage: A systematic Cochrane review. 6. Inhale deeply and exhale on a sustained note
Clinical Rehabilitation, 16, 61–68. (‘ahhhhhhhhh’)
Tamplin, J. (2005). The effects of vocal exercises and singing on the speech of people 7. Inhale deeply and sing a sustained sliding pitch note (as-
with acquired dysarthria. Unpublished master’s thesis, The University of Mel-
cending)
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Tamplin, J. (in press). A pilot study into the effect of vocal exercises and singing on
8. Inhale deeply and sing a sustained sliding pitch note (de-
dysarthric speech. Neurorehabilitation. scending)
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ume
Annals of the New York Academy of Sciences, 999, 364–373. 11. Inhale deeply and sing a sustained note decreasing in
Thaut, M. H. (2005a). Rhythm, music and the brain: Scientific foundations and clin- volume
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apy. Fort Collins, Colorado: ‘Robert F. Unkefer’ Academy of Neurologic Music
Therapy. Clinician provides a strong rhythmic pulse (patient may also
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auditory cuing on temporal stride parameters and EMG patterns in hemiparetic
gait of stroke patients. Journal of Neurological Rehabilitation, 7, 9–16. 1. Chant: i—eeee . . . i—eeee . . . i—eee . . .
Van der Merwe, A. (1997). A theoretical framework for the characterization of path-
2. Chant: eh—air. . . eh—air. . . eh—air. . .
ological speech sensorimotor control. In M. R. McNeil (Ed.), Clinical manage-
ment of sensorimotor speech disorders (pp. 1–26). New York: Thieme Medical.
3. Chant: oh—aw. . . oh—aw. . . oh—aw. . .
Yiu, E. M. L., & Ho, E. Y. Y. (2002). Short-term effect of humming on vocal quality. 4. Chant: ah—ahhh . . . ah—ahhh . . . ah—ahhh . . .
Asia Pacific Journal of Speech, Language and Hearing, 7, 123–137. 5. Chant: u—oohhh . . . u—oohhh . . . u—oohhh. . .
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Music Therapy Dysarthria Treatment Protocol
Melodic Articulation Exercises
1. Sing ‘oo ee’ arpeggios (5 arpeggios ascending by one tone
for each arpeggio)—e.g., CEGEC, DFAFD, EGBGE, FACAF,
GBDBG.
2. Sing ‘loo naa’ on alternating 2nds (x5, each time ascending
by one step up the major scale)—e.g., CDCDCD, DEDEDE,
EFEFEF, FGFGFG, GAGAGA.
3. Sing ‘dee paa’ on alternating 3rds (x5, each time ascending
by one step up the major scale)—e.g., CECECE, DFDFDF,
EGEGEG, FAFAFA, GBGBGB.
4. Sing ‘ka la’ using the interval of a 3rd (each time ascending
up the major scale by one tone)—e.g., CE, DF, EG, FA, GB,
AC, BD, C.
5. Sing ‘pitter patter’ using the interval of a 3rd, each time
ascending up the major scale by one tone, e.g., CEDF,
EGFA, GBAC, BDCE and then descending again, e.g.,
ECDB, CABG, AFGE, FDEC.
Rhythmic Speech Cuing
Chanted rhythmic phrases based on the stress patterns of
natural speech
Alternating patterns of stress are used to reflect changes in
meaning.
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29
Therapist provides metered rhythmic cuing—listen 1st time,
then chant each phrase twice.
For patients who have difficulty producing the words in the
phrases, each word can be modeled and practiced in isolation
before going through the phrase.
Vocal Intonation Therapy
Melodic, rhythmic phrases based on intonation patterns of
natural speech
Therapist provides metered rhythmic cuing—listen 1st time
then sing twice with therapist
For patients who have difficulty producing the words in the
phrases below, each word can be modeled and practiced in
isolation before going through the phrase.
Therapeutic Singing
1. Select 3 songs from patient’s list of 12 familiar songs that
are appropriate for the patient to sing while incorporating ar-
ticulation strategies. After 4 weeks, 3 different songs are to be
selected from patient’s list.
2. Explain and/or remind the patient of how to pace rhyth-
mically with the music and to focus on breath support and
articulation.
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Appendix B—Examples of Melodic Phrases used in VIT

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