Can People With Parkinson’s Disease Sing?

Linda Ronstadt perfoming in 1978

Linda Ronstadt perfoming in 1978

Not too long ago, superstar singer Linda Ronstadt told the world that she has Parkinson’s disease. Because of this, she said, “I can’t sing at all…I can’t sing a note.”

Along with a world full of music lovers, I am very sorry to hear of Ronstadt’s health struggles. I can only imagine how difficult it must be to lose one’s voice, and I recognize that it takes an extra dose of courage as a celebrity to share this kind of diagnosis, since she will inevitably become another “face” of this not-so-pretty disease. I doubt that anyone wants to be remembered for one of the worst things that happened to them.

Ronstadt has given us the opportunity, though, to have a new conversation about Parkinson’s Disease and, specifically, how it affects the voice.

What is Parkinson’s Disease?

Parkinson’s Disease is a neurological disorder that affects your motor system. Or, in other words, it’s a brain disease that affects how you move. You may have muscle tremors, slowed movements, rigid muscles, and difficulty with balance and walking. Parkinson’s is chronic, which means people live with it over the long term, and it’s progressive, which means it gets worse over time.

Fortunately, we have many medicines and non-pharmacological methods available now to control symptoms and slow the progression of the disease. For more information, I’d recommend checking out this summary from The Mayo Clinic. Additionally, The Michael J. Fox Foundation has a handy infographic about Parkinson’s and a Q&A on non-pharmacological methods that may help people living with this disease.

How does Parkinson’s Disease affect the voice?

Because Parkinson’s Disease affects the motor system, it affects the voice. After all, we use a lot of muscles to speak and sing, from the diaphragm to the larynx. Common symptoms related to speech include decreased volume, hoarseness, a breathy quality, monopitch, and imprecise articulation. Any of the symptoms that make speech difficult can make singing even harder.

Is singing impossible, though? In her interview with AARP Magazine, Linda Ronstadt said, “I now understand that no one can sing with Parkinson’s disease. No matter how hard you try.”

This isn’t strictly true.

Elderly choir

Of course, I don’t know Linda Ronstadt or what symptoms she is dealing with. I also realize that singing professionally – on a stage in front of audiences expecting a performance of a high caliber – is very different from singing along with the radio.

There is good news, though. The truth is that not only can some people with Parkinson’s Disease still sing, but for some people, singing is exactly what they need to help them maintain better speech and vocal functioning.

 

The Tremble Clefs: A Choir For People Living With Parkinson’s Disease

Enter one amazing, innovative idea: The Tremble Clefs. The choirs that are part of this nationwide program are all made up of individuals with Parkinson’s Disease and their spouses or caregivers. Not only do the Tremble Clef choirs offer a fun recreational music-making experience with people who understand what it’s like to have Parkinson’s, but they also can help to address speech and communication problems related to Parkinson’s Disease, through the breathing, stretching, singing, rhythm, and movement exercises that are built into rehearsals. You can see all the Tremble Clef choirs currently active here.

Music Therapy: Targeting Symptoms, Enjoying the Music

Of course, music therapy is another option for people living with Parkinson’s Disease. Music therapists can help people maintain vocal and physical functioning and cope with the emotional weight of having this illness, all through the medium of music. When you contact a music therapist about starting a music therapy program, you will first have an assessment session to determine what you want to get out of music therapy – where your biggest concerns are – and to talk about how music processes can help. The music therapist then helps to determine a treatment plan, targeting the goal areas you have identified.

You might spend time in a variety of music experiences – singing or vocal exercises, instrument playing, movement to music, musical improvisation – all depending on what you want to get out of music therapy. Over time, your treatment plan may change as your needs change, and you may decide to end music therapy when it is no longer helping you in the way you desire.

If you’re in Kansas City, contact me for more information about how music therapy could help you. If you’re not in KC, check out the American Music Therapy Association website to find a qualified music therapist near you.

I do hope that Linda Ronstadt will find a way to keep making the music she loves, even as her voice is affected by Parkinson’s Disease. My heart goes out to her at this difficult time for sure.

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Eldercare professionals: Learn more about helping older adults with music over at Soundscaping Source.

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When a Music Therapist Can’t Sing

I’m a pretty healthy person. Sure, I get headaches and the flu from time to time, but for the most part, I’m a healthy young-ish adult. I don’t really have much personal experience with a chronic illness or disability. Sometimes this feels like a liability, not knowing firsthand what it’s like to be an older adult or a caregiver for someone with long-term health problems. That’s why I am grateful for the glimpses into the experiences shared by so many of my clients.

Glimpses like the one I’m having now.

I will not sing, I will not sing, I will not sing…

I’m not allowed to sing.

This is a pretty big deal for a person who sings for a living and sings for enjoyment. Here’s what happened: I picked up a cold or something from my daughter a while back, then fall allergy season hit with full force. I got past the sniffle-sneezy-cough-cough-cough part of it all, but I still had a bit of a sore throat. Actually, I had throat pain, especially when singing, and especially on those days when I spend several hours singing and making music with clients.

I’ve heard from other music therapists about how crucial it is to take care of vocal problems immediately, so I made arrangements to see an otolaryngologist, also known as an ear, nose and throat physician, or “ENT.” I couldn’t get in for a week and a half, though, and admittedly, I pretty much kept going along as normal. I saw the ENT last Monday, who looked at my vocal cords with a fiber optic scope. They were red and swollen, indicating that there was a problem that could get much worse if I did not take action. My doctor gave me a prescription and told me that until our next appointment, I would not be allowed to sing. I could speak at a normal tone, as long as I avoided overuse. (The way he put it: “don’t defend a dissertation in the next two weeks.”)

As of today, I have been not-singing for over a week. I’ve cancelled several sessions to keep my workload down, and I’ve gotten creative with recorded and instrumental music in other sessions. I’m finished with my medication and am waiting for my appointment with the ENT next Monday.  In the meantime, I am waiting, avoiding places where I would most want/need to sing and talk, and hoping that this time is healing my throat.

I’m also doing a lot of thinking and reflecting on what this experience has to teach me, and I am seeing some similarities with what I hear clients and families talking about. Do any of these match your experience?

Reluctance to see a doctor. I didn’t wait too long to schedule an appointment, but I was definitely not looking forward to the appointment. I was kind of afraid of what he would say. I’ve heard these same feelings of reluctance from people who suspect Alzheimer’s but don’t want to deal with the ramifications of that diagnosis.

Relief at seeing the doctor. Mixed in with that reluctance was some relief at labeling the problem and being given a course of action to follow. This may be similar to the relief you might feel at getting an explanation for the strange behaviors a loved one has been having, or being given a prescription to help with symptoms.

Denial until “the doctor said so.” Even though I knew I should probably put myself on vocal rest, I didn’t really do it until the doctor said I had to. Then it was a relief to be able to say, “my doctor has me on vocal rest” when I started feeling guilty about not being able to keep up with business as usual. This reminds me of folks who don’t retire from driving until a doctor finally says, “you have to stop driving,” or family members who don’t start looking for assisted living or skilled nursing facilities until a professional says they really have to.

Difficulty following instructions. Health care professionals tend to sigh when talking about high rates of “non-compliance,” but sometimes those instructions are really hard to follow. I’m supposed to not-sing and use my voice as little as possible otherwise. For me, that’s much easier said than done. For you or your loved one, maybe the instructions that are hard to follow are taking the right pills at the right times, or changing your breakfast routine from bacon and eggs to oatmeal, or not crossing your legs after a hip replacement.

Frustration at communication limitations. I can’t holler down the stairs for my husband. I can’t sing “Twinkle, Twinkle Little Star” to my daughter at bedtime. I can’t call the dog in from the back yard. These seem like such small things until they’re gone. This makes me think of my clients with dementia who struggle to find the right words or my stroke survivor friends who have aphasia. (P.S. For an amazing portrayal of aphasia, check out this short film.)

Fear about the future. I was going to write “anxiety,” but really, it’s closer to fear. I’m afraid that I’ll have to change the way I work and interact with others, that I won’t be able to get back to normal. I don’t even know how rational my fears are. This is how many of my clients and families feel upon getting that diagnosis of Parkinson’s disease or “probable Alzheimer’s disease,” or after a stroke or traumatic brain injury.

Feelings of gratitude. Despite my fear and anxiety, I am grateful. I am grateful that the ENT has the technology to look at my vocal cords (right there in the office!) and tell me what to do. I am grateful for all of my clients who understand my need to slow down, reschedule, and/or do music in different ways than usual. I am also grateful that this problem is relatively small, that we caught it soon, that it doesn’t change who I am or what I am capable of doing in the long run. I see these same feelings of gratitude among folks who seem to have every right to be ungrateful, as a loved one’s abilities deteriorate, or their disease causes personality changes, or they seem to be in their last few days of life. It’s fascinating that we can hold all of these feelings at the same time and still be whole.

Mostly, I am grateful for this tiny glimpse into how life might be for some of the folks I care for. Being able to grow in empathy – that’s a gift in itself.

P.S. I’ve written similar reflections on growing in empathy here and here.

Song Spotlight: T’ain’t What You Do (It’s the Way That You Do It)

  • Mood: Lighthearted
  • Theme: Letting go and taking it easy
  • Tempo: Upbeat
  • Style: Calypso

I’m always looking for songs with catchy choruses that lend themselves to new song verses, and I recently found a gem: “T’Ain’t What You Do (It’s The Way That You Do It).” Written by jazz musicians Melvin “Sy” Oliver and James “Trummy” Young, this calypso song was first recorded in 1939 by Jimmie Lunceford, Harry James, and Ella Fitzgerald. It’s a popular song for dancing the shim sham, a wonderfully accessible jazz line dance. (Check out the instructional video here!)

The chorus is downright infectious:

Oh ‘t ain’t what you do it’s the way that you do it
‘T ain’t what you do it’s the way that you do it
‘T ain’t what you do it’s the way that you do it
That’s what gets results

Then, the verse reminds you:

You can try hard
Don’t mean a thing
Take it easy, greasy
Then your jive will swing

The rhythm is catchy and gets you moving. Continue reading

Song Spotlight: “Mama Tried”

Migrant Mother, Nipomo, California – Dorothea Lange

  • Mood: Regretful, Defiant, Wistful
  • Theme: Regret, Motherhood/Parenting
  • Tempo: Moderately Fast
  • Genre/style: Classic Country

Mother’s Day is coming up in a few days, and in honor of the holiday, I’ve been sharing many songs about motherly advice and love with clients in music therapy. In fact, a few that I’ve spotlighted before work well for this holiday, including Que Sera Sera, Shoo Fly Pie and Apple Pan Dowdy, Cuddle Up a Little Closer and Button Up Your Overcoat (although it’s a bit warm for that last one. Maybe it would work in the southern hemisphere?)

The fact is, though, that Mother’s Day isn’t always the happiest day, for the children or for the mothers. My heart goes out to mothers who have lost their children and children who have lost their mothers, as I know they are grieving at this time. My heart also goes out to the women who desperately want to be mothers but who have struggled with infertility or miscarriages. These losses leave holes in our lives that cannot be papered over.

And, I’m also thinking about the mothers who have been disappointed by their children. Parenting always involves ups and downs as children grow and life happens. Sometimes things don’t work out for the best, and sometimes children make serious and lasting mistakes, no matter how hard their parents tried to raise them well. This causes a different kind of pain, especially when you think that you are the reason why your child turned out this way. I’ve known mothers of adult children who have experienced this kind of pain. I’ve also heard the regret of folks who disappointed their mothers, who made those lasting mistakes and now can’t repair the damage. That’s the topic of this song spotlight: Mama Tried.” Continue reading

Song Spotlight: “Danny Boy”

  • Mood: Sentimental, Wistful
  • Themes: Ireland, Saying Goodbye, Missing a Loved One, Death
  • Tempo: Slow to moderate
  • Genre/style: Ballad

 

Photo courtesy PDPhoto.org

“Danny Boy” is one of those songs that is at once ubiquitous and mysterious. I’ve been singing this song a lot in the last week for music therapy sessions leading up to St. Patrick’s Day, and two clients reacted in ways that prompted me to do a little more research into this song’s background.

 

The first surprise happened when a client came up to me at the end of a group session at a nursing home and said, “You do know ‘Danny Boy’ is Scottish, don’t you?” I probably looked a little confused and responded that I hadn’t heard that and that I should probably look up more information.

Well, it turns out that this signature Irish song has both Irish and English roots. The melody is definitively Irish – it’s an anonymous folk tune known as “Londonderry Air.” Continue reading

How Music Therapy Brought a Couple Together Again

I started seeing this couple because he was on hospice and she was his caregiver. He had dementia, and his disease was causing him to be agitated and angry and sometimes even aggressive towards his wife. She was invested in keeping him at home as long as possible. As a nurse, she knew what she was getting herself into, and she wanted as much help as possible in helping her husband to stay calm. That’s why the hospice called me, the music therapist.

In our first session, he was dozing in his recliner, late in the afternoon following a dose of something sedating. I asked her about his music background and preferences, and she showed me his collection of CDs and the Bose stereo system that made him so proud. Continue reading

Song Spotlight: “Hound Dog”

Our newest family member - Duke the Basset Hound

  • Mood: Upbeat, full of attitude
  • Theme: Dogs and/or freeloading gigolos
  • Tempo: Moderate
  • Genre/style: Rhythm and blues/Rock and roll

We have a new family member in our house! This one gets around on four legs and has very long, droopy ears. His name is Duke, and he’s the adorable basset hound pictured above. I alluded to the inevitable canine addition to our household in this previous song spotlight post, but I thought his arrival was worth another song spotlight. Fortunately, that means I get to feature one of my go-to songs for elders both in group music therapy and in one-to-one interactions: “Hound Dog.”

“Hound Dog” is a 12-bar blues written by Jerry Lieber and Mike Stoller in the mid-1950s. Elvis Presley’s 1956 version is by far the best known, but the song was first recorded by Big Mama Thornton in 1952. To me, her recording has a more improvisational, blues-y feeling, with Thornton’s vocal interplay with the instruments and all of the musicians barking and howling like hound dogs at the end of the song. Big Mama Thornton’s version drew a lot of attention and was followed by no fewer than six cover versions by country musicians in 1953. You can hear one by Billy Starr here. Continue reading

Song Spotlight: “Cuddle Up a Little Closer, Lovey Mine”

  • Mood: Sentimental, tender
  • Theme: Love, physical tenderness
  • Tempo: Relaxed
  • Genre/style: Popular/Easy Listening

With Valentine’s Day coming tomorrow, I have been singing lots of love songs with my clients. There are so many GOOD love songs, too, which is to be expected, I guess, since love has been the subject of artists of all types for many generations.

My favorite love song of the moment is especially awesome for a few reasons:

  1. It works for romantic love as well as other kinds of love, like that between a parent and child.
  2. It encourages physical touch, but not in a overly sexual way.
  3. It’s in the public domain, so you don’t have to worry about copyright restrictions in experimenting with this song.

“Cuddle Up a Little Closer Lovey Mine” was published in 1908 as part of the Broadway music The Three Twins, with music by Karl Hoschna and lyrics by Otto Harbach. I learned it from a client of mine, who at the age of 99 can sing all of the words by heart. Here are the lyrics: Continue reading