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Finding a Voice & Social Connection
through Singing
Alison Talmage (RMTh) & Danielle Waterhouse (SLT)
Aphasia NZ Conference, 20 November 2015
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Haere mai!
Everything is ka pai!
You're here at last,
You're really here at last.
Haere mai!
Not a cloud in the sky
To coin a phrase,
It is the “day of days”.
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You’re welcome as the sunshine,
You’re welcome as a king,
Pai kare! This is one day
We’ll really have a fling!
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Haere mai!
Everything is ka pai!
Throughout the land
We want to shake your hand.
Haere mai!
We’re proud of you, that’s why.
Haere mai,
Haere mai.
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Presentation Overview
• Choral Singing Therapy in NZ
• Research
• So you want to set up a choir…
• Questions
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Warm up the body
Posture Shoulders Head and neck
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Exaggerated movements
Jaw Lips Face Tongue Soft
palate
Open mouth.
Drop jaw
down
Horse’s sneeze.
“Eee” - “Ooo”
Sour lemon.
Tiger face.
Ti - Kuh
Ka - LaYawn and
stretch.
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Warm up the fuel tank
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Warm up the voice box
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The teeth, the tongue and the lips…
• Pitch glides / sirening / humming
• Lip / tongue trills (br / r / z)
• Tongue twisters – rhythmic speech & consonant articulation
• Scale-based exercises – pitch accuracy
• Vowel / syllable discrimination & accuracy
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Peace, salaam, shalom
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Bella mama, bella mama e
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Banuwa banuwa
Banuwa yo
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Oh when the saints, oh when the saints,
Oh when the saints go marching in,
Lord, I want to be in that number,
When the saints go marching in.
Swing low, sweet chariot,
Coming for to carry me home,
Swing low, sweet chariot,
Coming for to carry me home.
She’ll be coming round the mountain when she comes,
She’ll be coming round the mountain when she comes,
She’ll be coming round the mountain,
Coming round the mountain,
Coming round the mountain when she comes.
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Therapeutic Choirs in
New Zealand
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CeleBRation Choir
Established: 2009
Context: The University of Auckland - Centre for Brain Research, Dept. of Speech Science,
Participants: Approx. 40 adults (mainly 65+, some younger)
living with neurological conditions (50% stroke), carers, volunteers
Therapists: Alison Talmage RMTh and Shari Storie RMTh (job share),
advisors and researchers from the Centre for Brain Research
Researchers: Prof. Suzanne Purdy and multidisciplinary SPICCATO research team
Funding: Free to participants.
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Established: 2012 by TPL, Kimberley Wade (RMTh) & Susan McDonald (SLT)
Participants: Approx. 35 adults with neurological conditions esp. stroke, brain injury
& Parkinson’s disease
Other attendees: Carers, volunteers, SLT students
Therapists: Kimberley Wade (RMTh) and Danielle Waterhouse (SLT)
Professional links: University of Canterbury
Funding: Therapy Professionals Ltd, NZBRI, NZ Music Foundation, Canterbury
Community Trust, $10 entry fee for members.
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Aphasia: Why might
singing help?
• Music exists in all cultures
• Group singing boosts mood and improves quality of life
• Positive changes in the body
• Holistic, strengths-based, patient-led
• Speech and singing areas of the brain overlap
• Singing may be preserved when speech is impaired
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Thoughts from the Cantabrainers Choir
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Choirs and Neurorehabilitation
• Neuroplasticity: “the capacity for neurons to structurally and functionally adapt.”(Kleim, 2011)
• Applying this to a therapeutic choir
• repetition matters
• intensity matters
• time matters
• salience matters
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Singing and word finding
When singing, word retrieval facilitated by
• both sides of brain used (Ozdemir, Norton & Schlaug, 2006)
• decreased speed (Stahl & Kotz, 2014)
• rhythm (Stahl & Kotz, 2014)
• useful phrases (Stahl & Kotz, 2014)
• use of familiar, repetitive songs
A-FROM, Kagan (2011)
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Increasing participation in life
• new friendships and sense of community
• a new hobby
• practice communicating with others
• supporting others, contributing to the
group
• autonomy within the group
• opportunities for new roles
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The Choir Environment
• wheelchair friendly
• aphasia friendly instructions and information
• trained support staff and volunteers
• good time of day
• no/low cost
• song choice (simple, repetitive, familiar)
• positive attitudes of others
• access to RMTh and SLT
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Helping People Grow
• encouragement to take risks (solos, duets)
• challenging unhelpful personal beliefs
• feelings of independence and efficacy
• increased confidence
• increased motivation
• increased knowledge about aphasia
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SPICCATO Feasibility Study (2011)
Stroke & Parkinson’s: Investigating Community Choirs and Therapeutic Outcomes
Convenience sample – CeleBRation Choir members and carers
Prof. Suzanne Purdy and multi-disciplinary research team
Mixed methods – voice measures, questionnaires, interviews, focus groups
Supported communication
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Social connection
“Anything that takes them [people with
stroke] out of their comfort zone is a really
good thing. Anything, like the choir. I can
just think of so many people that should’ve
been going to that choir and they probably
wouldn’t leave the house.”
(Stroke significant other)
Recovery of abilities
Researcher (R): So when you first went to
choir, why were you going?
Stroke participant, male, 43y: Basically I just
wanted to, talking [gestures to do more of it
R: So you thought it would be like a therapy?
SP: Yeah.
R: Therapy or just opportunity to talk?
SP: No, no therapy. Because you guys
[therapists] are here so you know what to
talk.
R: So you thought the singing would help
your talking?
SP: Yeah. And I didn't worry if my singing
was crap [sic] or good.
Musicality
“Even though she can’t speak, she could
sing every song played.”
(Stroke significant other)
(Fogg Rogers et al., 2015)
Needs
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Group singing
(Fogg Rogers et al., 2015; Talmage et al., 2013)
Song choice
Music therapist
interaction
Session environment
Mixed neurological conditions
Barriers and access
Choir Experience
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Mood
R: So what do you enjoy?
SP: Singing, and, “Hi, how are you?” and
everything.
R: So meeting people?
SP: Yes. And singing and laugh sometimes.
(Stroke participant, female, age 65):
Shared fun interest
It’s lovely just to sit in there singing away too, and just to
look around and watch everybody participating at their
own level, in their own way, with no pressure. They don't
have to do 10 of those or eight of those. And it’s such a
level playing field. It’s a joy to behold, honestly.
(Stroke significant other, female, 66y)
Voice, breathing, language
SP: And sometimes, [participant uses
gaze, alternating between two people, to
convey the importance of watching the
music therapist]
R: If you watch her?
SP: Yes, and sometimes... [indicates
words or song coming out of her mouth]
(Stroke participant, female, age 65):
(Fogg Rogers et al., 2015; Talmage et al., 2013)
Benefits, new abilities, connections
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The Music Therapist’s Role
• Musical leadership
• Balancing group and individual needs
• Multi-disciplinary collaboration
• Personal qualities
• Promoting the special nature of the choir
• Supporting research (Talmage et al. 2013)
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The SLT’s Role
• 1:1 support (Cantabrainers Choir)
• Advice and research (CeleBRation Choir)
• Liaising with the MTh
• Education
• Learning from the MTh
• Holistic approach
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So you want to set up a therapeutic choir…
• Research and theory
• Identified demand and referral system
• Local expertise – participants and carers, RMThs, SLTs, admin
• Networking and support
• Funding and resources
• Organisation: venue, access, frequency, time, volunteers…
• Evaluation and research
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Contact us
Music Therapists
Alison Talmage [email protected]
Shari Storie [email protected]
Kimberley Wade [email protected]
Megan Berenston-Glass [email protected]
Penny Warren [email protected]
Music Therapy NZ www.musictherapy.org.nz
Speech-Language Therapists and Speech Scientists
Prof. Suzanne Purdy [email protected]
Dr. Clare McCann [email protected]
Sylvia Leao [email protected]
Danielle Waterhouse
Naomi Seow [email protected]
Robin Matthews [email protected]
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References
Baker, F., & Tamplin, J. (2006). Music therapy methods in neurorehabilitation: A clinician’s manual. London: Jessica
Kingsley Publishers.
Rogers, L., Buetow, S., Talmage, A., McCann, C., Leão, S., Tippett, S., Leung, J., McPherson, K., & Purdy, S. (2015 July).
Choral singing therapy following stroke or Parkinson’s disease: An exploration of participants’ experiences.Disability
and Rehabilitation, 1-11. [Epub ahead of print]. DOI:10.3109/09638288.2015.1068875
Kleim, J.A. (2011). Neural plasticity and neurorehabilitation: Teaching the new brain old tricks. Journal of communication
disorders, 44, 521-528.
Talmage, A., Ludlam, S,. Leao, S., Fogg Rogers, L., Purdy, S.C. (2013). Leading the celebration choir: the choral singing
protocol and the role of the music therapist in a social singing group for adults with neurological conditions. New
Zealand Journal of Music Therapy, 11, 7-50.
Ozdemir, E., Norton, A. & Schlaugh, G. (2006). Shared and distinct neural correlates of singing and speaking. Neuroimage,
33, 628-635.
Stahl, B. & Kotz, S.A. (2014). Facing the music: Three issues in current research on singing and aphasia. Frontiers in
psychology, 5:1033. doi: 10.3389/fpsyg.2014.01033.
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Questions
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Celebrating Music Therapy
21-29 May
2016
Brain Day
12 March
2016
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NOW IS THE HOUR
Pō atarau e moea iho nei
E haere ana koe ki pāmamao
Haere rā ka hoki mai anō
Ki i te tau e tangi atu nei
Now is the hour when we must say goodbye.
Soon you’ll be sailing far across the sea.
While you’re away, oh, please, remember me.
When you return, you’ll find me waiting here.