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“A Language I Could Speak Fluently”: Using Music and Rhythm for Fluency Disorders - featured January 26, 2012

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“A Language I Could Speak Fluently”: Using Music and Rhythm for Fluency Disorders

By: Kimberly Sena Moore, MM, NMT-F, MT-BC
Board Certified Music Therapist

The first real breakthrough for King George VI came when his speech therapist, Lionel Logue, had him read pages of text while listening to music through headphones. King George VI, known as “Bertie” to his family, had struggled with stuttering from an early age. He exhibited the classic behaviors, repeating words or parts of words and prolonging sounds.

But with the music blasting and drowning out his ability to hear himself talk, Bertie’s speech came through fluently and without disruption.

This scene is from the 2010 movie The King’s Speech, starring Colin Firth as King George VI and Geoffrey Rush as Lionel Logue. Although the director and producers may have taken some artistic license, this scene highlights a type of treatment that has the potential to help children and adults who stutter: music therapy.

What is music therapy?

According the American Music Therapy Association (AMTA), music therapy “is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” (AMTA, 2012).

Music has the ability to touch our brains and our bodies in unique, complex, and profound ways. It can make us feel a certain way, stimulate our memories, help our bodies move in time, enhance social cohesion, and promote cognitive learning. It’s for reasons like these that, when provided by a qualified professional, music therapy can be a very powerful treatment tool.

When it comes to helping those who stutter, the research literature is small, but promising, and the clinical support is building. Current clinical music therapy techniques used to help increase fluency include singing, rhythmic cueing, music and relaxation, and oral-motor strengthening.

Singing

Most of the research to date has focused on the use of singing for enhancing fluency for those who stutter. Julie Neal, MS, MT-BC, a music therapist in the Montgomery County Public Schools in southwest Virginia, says that, in her experience, “those who have ‘stuttering’ or fluency issues tend to see a decrease or complete elimination of symptoms while singing, provided the rhythm is steady and predictable.”

Research on the observation that singing increases speech fluency began in the 1970s and continues to this day (Andrews et al. 1982; Colcord & Adams, 1979; Davidow et al., 2009 ; Healey et al. 1976). But how does it work? Researchers are still working on the underlying mechanisms and Wan et al. (2010) postulate that it may be because singing provides increased phonation duration, intonation, and/or has a shared auditory-motor pathway with speech.

From a clinical standpoint, Neal recommends working with individuals who stutter on singing or chanting to a steady and predictable beat in a comfortable vocal range.

Rhythm

One of the most powerful musical elements is rhythm. For individuals who stutter, the power of rhythm may help provide a timing cue to facilitate oral-motor production and coordination.

Dr. Blythe LaGasse, MT-BC, a professor of music therapy at Colorado State University (http://www.colostate.edu), says that “the rhythm in music is structured and anticipatory, providing cues that can facilitate the timing of speech production. In some cases, the music therapist can use rhythm to slow the rate of speech (and) to promote a more controlled production of syllables.” She goes on to say that research literature to date shows these are short-term effects.

When using rhythm-based treatment interventions, a music therapist may provide a steady rhythmic beat and have the client either speak naturally to the rhythm or speak syllabically (e.g. one syllable per beat). This rhythm would provide a template to help the individual organize his or her speech output.

Rachel See Smith, MA, MT-BC, has a B.A. in Communication Disorders, an M.A. in Music Therapy, and is the founder of Music Therapy Services of Austin (http://www.musictherapyservices.net). She points out that the music therapist can enhance the rhythmic effect by incorporating multi-sensory cues, such as a visual cue through the movement of a mallet striking a drum, or a tactile cue like rhythmically tapping the client on the arm or shoulder.

Relaxation


John M. Williams wrote a review of The King’s Speech that is posted on the Stuttering Foundation’s website (http://www.stutteringhelp.org). In this review, he sympathized with the anger, embarrassment, and stress portrayed by Colin Firth as his character, Bertie, struggled with stuttering (Williams, n.d.).

Music can be used to help promote relaxation, which may in turn help facilitate speech fluency. There are a variety of music and relaxation techniques available, from making music to listening to music.

Raschell West, a music therapy student at the University of Missouri-Kansas City who herself lives with stuttering, says “(g)rowing up I struggled a lot with expressing what I meant through words and often found myself extremely defeated when it came to expressing myself to others...The music I made had a consistent beat and always made something beautiful. I found and still find it calming. It brings me back into check, calms me down, and re-starts my train of thought so that I can try once again to communicate.”

Oral-Motor Control

The final way that music therapy can be used to help those with fluency disorders is through working to develop and strengthen the breath support and oral-motor strength that underlie speech. It’s like doing pre-gait exercises when helping someone who has had a stroke re-learn how to walk; it is an indirect way of working on increasing fluency through strengthening and enhancing the underlying oral-motor mechanisms of producing speech.

As Rachel See Smith says, “(t)hrough singing and instrument-playing interventions, the music therapist can assist the client in utilizing their breath and muscle control. There are a variety of instruments that serve as a bio-feedback mechanism for fluency clients, such as the kazoo or the harmonica.”

If you are interested in finding a board-certified music therapist, please visit the Certification Board for Music Therapists website (http://www.cbmt.org) and click the “Find a Board Certified Music Therapist” link. Whether through receiving direct care services or working with a music therapist as a consultant, perhaps your loved one will one day have a similar story to share as Raschell:

“I’ve always found literal language difficult to fully produce. Growing up I struggled a lot with expressing what I meant through words and often found myself extremely defeated when it came to expressing myself to others. More complex (thoughts) get stuck and it’s like I have to sound out the word in my head and the parts I get come out while the rest is left behind. I never told my parents but I found for myself that music was very helpful. It was a language that I could speak fluently, (without) stumbling over certain consonants...”

References

American Music Therapy Association (n.d.). What is Music Therapy? [Website] Retrieved from http://www.musictherapy.org/about/musictherapy/

Andrews, G., Howie, P.M., Dozsa, M. & Guitar, B.E. (1982). Stuttering: Speech pattern characteristics under fluency-inducing conditions. Journal of Speech and Hearing Research, 25, 208-216.

Colcord, R.D., & Adams, M.R. (1979). Voicing duration and vocal SPL changes associated with stuttering redution during singing. Journal of Speech and Hearing Research, 22, 468-479.

Davidow, J.H., Bothe, A.K., Andreatta, R.D., & Ye, J. (2009). Measurement of phonated intervals during for fluency-inducing conditions. Journal of Speech and Hearing Research, 52, 188-205.

Healey, E.C., Mallard III, A.R., & Adams, M.R. (1976). Factors contributing to the reduction of stuttering during singing. Journal of Speech and Hearing Research, 19, 475-480.

Wan, C.Y., Rüber, T., Hohmann, A., & Schlaug, G. (2010). The therapeutic effects of singing in neurological disorders. Music Perception: An Interdisciplinary Journal, 27(4), 287-295.

Williams, J.M. (n.d.) The King’s Speech [Web log post]. Retrieved from http://www.stutteringhelp.org/default.as...&tabid=875



This Month's Featured Author Kimberly Sena Moore

Kimberly Sena Moore, MM, MT-BC is a board-certified music therapist, a mommy, and a first-year PhD student at the University of Missouri-Kansas City. She writes about music therapy and therapy business management through her blog Music Therapy Maven, talks about music for health and wellness through her Psychology Today blog Your Musical Self, and co-hosts the Music Therapy Round Table podcast. Connect with Kimberly on Twitter at @KimberlySMoore.

Kimberly would like to thank Dr. Blythe LaGasse, Krystal Demaine, Rachel See Smith, Julie Neal, and Raschell West for sharing their thoughts, insights and expertise.

Please support our contributing authors and visit her Psychology Today Blog at Your Musical Self and her
Music Therapy Maven Blog

Tags: Music Therapy Stutering SLP Article Newsletter 27 January 2012