As a voice and Alexander Technique teacher who teaches singing lessons for kids and adults in Marin County, I have had occasion to work with students affected by Parkinson’s Disease. Parkinson’s, as defined by the Parkinson’s Foundation, “is a neurodegenerative brain disorder that progresses slowly in most people. …A person’s brain slowly stops producing a neurotransmitter called dopamine. With less and less dopamine, a person has less and less ability to regulate their movements, body, and emotions.” Aside from such symptoms as fatigue and sleep interruptions, efficiency of movement and motor skills and memory can become impaired.
So, how does Parkinson’s affect the voice? Well, all the symptoms that surface in the whole body can surface in speech – stiffness in the vocal mechanism, such as the root of the tongue and jaw, leading to loss of clear articulation; slowness of reflexive rib expansion, diaphragmatic weakness and insufficient breath, and inefficient vocal patterns, such as starting the sound at the bottom of the exhale. Also, PD students’ voices may have tremors or speak in a monotone due to stiffness in the cords. According to the PD Foundation, PD patients can have a “soft voice, mumbled or fast speech, communication problems, and swallowing issues.” They can also suffer psychosocial isolation based on vocal frustration.
Another manifestation of PD is a blank face or what is called “masking.”
Many people affected by PD are on the medication Levodopa, called L-Dopa, which is synthesized in the brain as dopamine. It has given many sufferers a new lease on life, helping with motor symptoms. For some with more advanced PD, Deep Brain Stimulation has been used to address gait and masking. However, not all these interventions work with the stooped posture, cognitive loss, and freezing of gait that is familiar in PD sufferers.
The Alexander Technique, however, is now on the medical community’s radar as a modality that seems tailor-made for people living with PD because it works specifically with balance and gait. It is helping people recognize and get rid of pre-existing patterns that interfere with efficient movement, starting with the head-neck joint, which often stiffens with people living with PD. I have helped a student with PD learn how to get out of bed without pulling on the neck, improve balance, stay in their spine while on a walker and sit/stand more efficiently so using the toilet is easier.
And in the vocal arena, guess what else the PD Foundation suggests? Singing! The “bigness” and dynamic of singing has wonderful therapeutic value, keeping breath flowing and support engaged. And it can help people with Parkinson’s gain aural feedback on their voice. PD can interfere with people’s kinesthetic sense – sometimes someone THINKS they are doing something, like dropping their jaw, but really aren’t. And, of course, singing does great things for our mood, which can be an issue for these students.
I am not a speech therapist or pathologist. However, voice and singing teachers are very knowledgeable about the voice and have many practices to free breathing, strengthen “vocal support” and phonation and keep articulators such as the tongue and jaw flexible. (There is actually a new profession joining hospital “voice rehab” teams: the singing voice rehabilitation specialist, sometimes speech therapists, but not always, who sing.)
For instance, as any singing or theater student knows, playing with the face muscles can affect your sound – think “the inner smile” to lift the palate or the classical “sneer” in the lower register. I often have students warm up by smiling and lifting the eyebrows, puckering and frowning the eyebrows, circling the tongue around the outside of the teeth inside or outside the mouth, sticking it out and rolling it forward. For people with PD, these exercises could help facial flexibility and delay “masking.” To my initial surprise, the PD Foundation’s experts suggested all these fun singing lessons in their literature.
I have been very honored and inspired by my students who live with Parkinson’s. And, I have been very excited to keep learning so I can continue to create exercises to help PD students stay vocally healthy and active through the years. If you are someone affected by Parkinson’s, I invite you to try Alexander Technique and voice lessons with me here in Marin and see what you think.