Liedtherapy, by Ambra Noé
Patients coming for the first time complain that they have a low tone of voice. That they stumble, stutter, breathe with difficulty.
Phonetic alterations in Parkinson’s patients are linked to aphasic-anarthric disturbances with two components in particular: one, the lowering of the voice, is paretic, the other, the buccofacial apraxia, is dyspraxic. The volume is more evident when it combines with impediments of an expressive-linguistic nature.
I take my inspiration from the Lied because of its perfect linguistic-musical fusion, the precision of its rhythmic-expressive movement, but also from Sprechgesang, singing-acting and Gregorian chant. I combine this with a thorough knowledge of the physiology and phoniatrics of the singing voice and of neurological pathologies.
I have devised a method that arises from my experience as a teacher with the capacity to train exceptional voices. The result is a system for the recovery of the voice and of language, containing those psycho-linguistic and vocal production aspects which are lacking in such traditional methods as speech therapy and Silverman.
In 2004 I took part in a brief experiment for the doctoral thesis of a future neurologist on Parkinson’s patients treated with DBS. Since then I have dealt with over a hundred patients in at least six associations. And not only Parkinson’s.
With notable benefit to volume, voice production activities and linguistic ability. As well as psychological and relational benefits. Sound is divided into its principal characteristics: timbre – length – intensity – pitch –intonation – accent. As a test I ask the patient to read a short piece. The volume tends to weaken during the reading. This is in part due to an inability to economize their breath sufficiently to reach the end of the sentence.
When Broca’s aphasia is present, in the zone of the brain that deals with language, the most suitable word becomes hard to find, the voice becomes confused and the patient may reach a total block. The discourse becomes inexpressive, precipitate or broken. From the psychological aspect we have situations of nervousness/panic, a sense of inadequacy. These lead to negative considerations.
A broken voice is often the consequence. This is not only the result of technical incapacity, it is also caused by motorial impediments strongly linked to psychological unease.
In the singing test the voice rises without covering the sound, raising the larynx and compelling the muscles to a sense of phoniatric fatigue because of the lack of collaboration between the vocal muscle (thyroarytenoid) and the cricothyroid in producing high/low notes and harmonics.
Problems of deglutition also arise where the epiglottis, which has the shape of a leaf with a stalk acting as the entry valve to the larynx, remains static, obstructing the normal transit of the alimentary bolus towards the oesophagus.
Exercises designed for this specific purpose lead to LOWERING OF THE LARYNX, THE JAW AND THE LINGUAL BASE, ENLARGEMENT OF THE OROPHARYNGEAL CAVITY, LIFTING OF THE SOFT PALATE.
Increased muscular hypofunction through singing is practiced with voice-warming “vocalises”, suited to the specific features of the patient within the limits allowed by the illness.
To those who fear contact with a subject they have never had anything to do with, I wish to say that we work on intensity rather than volume, in line with the vocal features of the patient, in order not to betray their nature. Exercises for small groups are always studied individually and I do not agree with treatments that tend to make the patient shout .
An important aspect is the practice and knowledge of the resonators. I consider 12 out of 18 as determining vocal characteristics, for example the pharyngeal (the speaker), the apical (the child’s voice), the prepalatal (the whiskers’ voice), the uvular (the Scandinavian sound), etc.
It is fundamental to recover use of the muscles intended for breathing and phonation. This provides the means to start the sound and to create phonemes, and produces the launching pad with which to build and formulate speech, equipping the patient with an internalized rhythmic mechanism.
Interaction of great impact is created because the patient, helped by the sound, by a professional voice and by the careful practice of gradual, pleasing exercises, recovers an important component: faith in himself.
The exercises also encourage a correct posture because they oblige the patient to counteract the tendency of Parkinson’s patients to stoop.
The cycles should be repeated annually with at least twenty lessons.