I was 20 years old when I had my first encounter with someone who has Parkinson’s Disease (PD). “Johnny” was a retired dentist, pianist, and former big band leader. I was an undergraduate student, music therapy major, and his home health aide. Johnny did not present with the most recognizable symptom of PD, the resting tremor—he would raise his arm, holding it parallel to the floor, and as it floated say, “My doctor says I have Parkinson’s Disease, but I’m not sure. See? No tremor!”—but he did have the bradykinesia (slow movement) and muscle rigidity. It was difficult for Johnny to get around his house, be independent with his daily activities like eating and dressing, and he sorely missed playing the beautiful grand piano resting in the middle of the living room.
Johnny is responsible for illustrating to me the link between the human auditory and motor systems. As mentioned, it was difficult for Johnny to get around his house. He lived in a long ranch, with his bedroom at one end of the house, and a dayroom at the other. Every morning, once ready for the day, Johnny and his walker would begin the trek down the length of his house, starting from the bedroom, walking on carpet, then shifting to the wood foyer, then back to carpet, before reaching the dayroom at the far end. And every day it would take Johnny time to begin (initiate) his walk, then he would falter (freeze) every time the flooring changed, then stall when needing to turn and enter the dayroom. The whole process would begin again at night, as Johnny worked his way from the dayroom back to his bedroom at the other end of the house.
One day we stumbled upon something that would end up helping Johnny on this twice daily haul. Given our shared history as musicians, it’ll come as no surprise that Johnny and I often talked about music. As Johnny was prepping to take the first step, we joked about singing a march so he could march his way down the hall. It was Johnny’s idea to use Sousa’s “Stars and Stripes Forever”, a march he liked. As I sang through the musical introduction, Johnny sang along and started marching in place. On the downbeat of measure five, when the first theme begins, Johnny moved his steps forward, and began marching (and singing) his way to the dayroom. No freezing of his gait as the flooring changed, no difficulties with initiation, and a smoother transition turning into the dayroom at the end of the hall. It was an instantaneous difference in the speed, length, and smoothness of Johnny’s gait.
What Johnny and my 20-year-old self stumbled upon was nothing new. Marching band members, military leaders, and dancers can all speak to the ability for the human motor system to entrain, or synchronize, to a steady rhythmic pulse. Furthermore, this connection has clinical applications. For example, in 2013, Lindaman and Abiru published a review of literature exploring the effect of Rhythmic Auditory Stimulation (RAS: a specific music-based intervention designed to improve gait through the application of a steady rhythmic beat) on gait patterns in individuals with PD. In general, they reported that RAS resulted in improvements in gait velocity, cadence, stride length, and balance, and decreased freezing during turns.
Furthermore, suggestions were made regarding how best to use music, such as utilizing a slower tempo for those who present with gait freeze, but a faster tempo for those who do not.
Gait is not the only area in which music-based interventions might make a difference. Many individuals with PD present with hypokinetic dysarthria, a term which describes speech and voice abnormalities associated with PD, such as reduced loudness, fast speech rate (which leads to poor intelligibility), and monotone voice (i.e., decreased vocal range). Given these connections, some researchers have explored the impact of a group singing intervention on these parameters. Overall, these singing-based interventions resulted in improvements in speech intelligibility and articulatory control, and well as in vocal intensity and vocal range.
The third area of study concerns the influence of music-based interventions on mood and quality of life. Though these often seem of secondary interest, researchers have noted connections between poor communication skills or living with a degenerative disease with depression and quality of life. Overall, research indicates that variables of depression and quality of life seem to improve following music-based interventions such as RAS, group singing, and general group music therapy.
In closing, we’ve touched on several evidence-based ways in which music interventions can be used to improve the physical, communication, and emotional skills of individuals living with PD. As I sit here and remember Johnny and our Sousa-singing walks down the hall, I’m struck by the thought that these experiences we shared went beyond helping Johnny walk more quickly and easily down the hall—they were also done while singing (during walking, no less!) and with smiles on our faces.
So perhaps there were other musically-driven benefits for Johnny of which my 20-year-old self was unaware.
Featured Image Credit: piano, music by Lukas Budimaier. CC0 Public Domain via Unsplash.