Page 38 - NAMAH-Oct-2020

Namah Vol. 28, Issue 3, 15th October 2020

structure facilitates better coordination of the and intelligibility of dysarthric speech (8).
articulatory muscles. In that sense, the speech
motor function shows the same sensitivity Therapy procedure
to rhythmic entrainment as can be seen
in gross or fine motor functions. In other 1. Diagnosis and clinical assessment
words, the acoustic rhythm seems to facilitate
better motor programming in the process of Before starting the music therapy sessions,
speaking. This certainly holds true for all it is essential to define the speech pathology.
forms of dysarthria in which muscle functions When assessing the speech problem, three
are impaired. Considering the therapeutic questions need to be addressed:
mechanisms for RSC in dysarthria slowing
down is clearly the main impact in terms of • Is it a form of altered speech due to a neurological
functional gains in intelligibility. disease?
• Does the altered speech pattern cause any objective
Van der Merwe states that musical exercises in or subjective problem for the patient?
which speech movement patterns are mimicked • Does the prognosis of the symptom justify initiating
or practised are more likely to cause the neural therapy?
adaptation necessary to improve speech
precision than in simple resistance exercises If all three questions are answered in the
focused on building oral muscle strength. affirmative, the patient should be referred for
Both speech and singing involve the use of therapy.
muscles of respiration and articulation and
contain elements of rhythm, pitch, dynamics, 2. Developing the clinical goal/objective
tempo, and diction. It is not surprising
then, that speech and singing share many Once the speech pathology has been thoroughly
of the same neural mechanisms, which described, the second step consists of the
can influence each other in a therapeutic development of appropriate and measurable
process. In singing, the word production therapy goals and objectives. So in this step,
rate is slower than in spoken language, and according to the findings of the assessment,
rhythmic and melodic speech inflections are we define a clear and realistic aim like 1)
more pronounced. While singing, a clear improve intelligibility; 2) sharpness of articulation;
rhythmic cue is provided from the song that and 3) speech fluency
helps to stimulate and organise the motor 3. Design of functional, non-musical therapeutic
function of the oral muscles. This rhythmic exercise
cue is especially strong while singing single
syllables or sounds, and supplies an organised This step consists of the design of therapeutic
and highly repetitive frame through the song exercises, structures, or therapeutic stimuli
presentation. Special singing exercises can be to accomplish the clinical objective. To assess
used that support and shape oral fine motor the natural speech rate and/or fluency of a
skills in order to enhance coordination of the patient is to record their free and consecutive
lips, tongue, and movements of the jaw. Such speaking for one minute and then count the
improvement can result in better articulation syllables while listening to the recording.

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