Saturday, March 21, 2015

Singing and Speaking Aphasia Speech Therapy

March 18 / 2015

Many have asked me about the relationship between speaking and singing and what my opinion was regarding the use of Music therapy as an adjunct to or replacement for speech and language therapy.  

Many have invested a great deal into the process of music therapy and singing and hoping it will have a positive influence on the ability to speak.  Having worked with people who have had brain injury and aphasia, I have explored the use of singing as an adjunct to speech therapy and have found it to be an enjoyable activity that helps build confidence in uttering lyrics from songs once learned, rhythm and melody can also help facilitate some production of words.

Singing is dependent on rote memory that occurs due to the repetition of a given group of words over and over again throughout ones childhood and lifetime. Sometimes the words do not even make sense like many of the songs we grew up with as teenagers, but it did not matter since it was the "melody" that we liked so much.  Being able to repeat a song, or catchy jingle develops through rote repetition.  Singing helps reinforce and stabilize the learning of a song.  It seems like a miracle, doesn't it, when one who is unable to construct a thought with words can sing the words normally?  

Whereas speech is a very different process.  One must gather a thought in the mind, (develop and construct), then go to the brain depository where all the words are (lexicon), and select, in order, the words one wishes to say in a split second and at a "conscious" level with appropriate grammatical structure also.

Now here's the rub:  Singing is rote, but speaking requires conscious formulating of thoughts into words for those with aphasia.  To those normal speakers it is an automatic process that requires formulating thoughts into words and articulating all of the sounds of those words accurately at a fraction of a second.  The person with aphasia needs a great deal more time to find and formulate words he wishes to say as long as the sounds of those words are formed correctly.  

Formulating speech and language for those with aphasia for many is a very slow and tedious process that often causes listeners to get impatient with the speakers attempts to communicate.  It’s quite a different process.  For speaking to improve, one must develop the skills of speaking which require the repetition of thoughts, vocabulary, needs, desires, feelings and expressions with words throughout the day in daily activities, each and every day.  That is what caregivers and therapists are learning with the Teaching of Talking Method; very similar to going back through the process of how we learned to speak:  single words, two word pairs, with a gradual increase with word length as each step is practiced and learned.  

To me it's like a computer crash that requires re-formatting the "hard drive," and re-inputting all the data.  There are no short cuts, and one must often start from the beginning and start saying simple words, word pairs, phrases, sentences, etc.)  And then there is the faith required that the hard drive will accept the new information or begin outputting the correct information that was stored there.    

One must be cognizant of the fact that singing, is quite unlike actual speaking, and the steps to better speech require the process of cued talking whenever the words are necessary, very much like what mothers and fathers do when children are developing language and speech.  Rhymes, vocabulary, repetition of words and thoughts from conversation, books and lots of enriching new experiences with new vocabulary repeated often.

As a side-note:  while drafting this article, in error I deleted it by accident after spending over an hour on it.  No matter what I did, the document could not be retrieved.  My first inclination was “all that work…gone, due to an error!”  I am NOT GOING TO RE-WRITE IT!  TOO MUCH WORK!!!!! A moment later I read a post about a caregiver’s frustration with what to do for her mother who lost her speech due to aphasia and her curiosity about singing as a viable therapy for speech loss.  

I then came to the realization:  YOU HAVE TO RE-WRITE IT!  A similar thought most probably occurs from both caregiver and person with a sudden onset of aphasia and speech loss; YOU CAN’T GIVE UP…. You just have to do whatever it takes, once you have some understanding of what you are dealing with…

Someone who is trained and experienced to work with neuro-patients and licensed in music therapy should provide it like any other discipline in rehabilitation or medicine.  If used for the purpose of improving speech it should be done in coordination with a speech language pathologist and should not be done independently for speech purposes.  Like any other specialty in rehabilitation, the speech pathologist has been trained to specifically deal with all of the aspects of speaking and is well versed in the diagnosis and approach to treatment.  He or she would know the appropriate goals to set for the improvement of speaking.  

Music therapy may be recommended as an adjunct to speech therapy, particularly if the speech language pathologist has assessed that it would be helpful and is familiar with the music therapist s/he is recommending. The Certification Board for Music Therapists ( provides a national registry of certified music therapists in the United States. MT-BC's (about 5000 in the US) are largely graduate trained professionals who have to complete 1030 hours of clinical, supervised training before sitting for the board exam. Music therapists can serve to adjunct speech therapy, provided that the goals are coordinated. 

As with any other therapy, it is always prudent to find the appropriate speech professional to address your speech needs and to discuss any concerns or questions you may have regarding additional modalities or approaches to treatment.  

Moshe Mark

Moshe Mark Ittleman is a senior speech language pathologist who has been helping people speak with clarity for over 40 years.  He spent years and continues today in direct one on one speech therapy with those who have had brain injury, aphasia and children who had not developed speech and language normally. He has worked in nationally renowned rehabilitation hospitals and developed specialized programs for those who lost their speech due to aphasia. He is the author of The Teaching of Talking, Learn to Do Expert Speech and Language Stimulation with Children and Adults, which is available in book, Kindle, and format and a soon to be released video training course:  for therapists and caregivers.

Moshe Mark Ittleman, M.S., CCC/SLP
Senior Speech Language Pathologist
Author:  Teaching of Talking
Video Training Course for Caregivers and Therapists

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