Therapeutic Singing as a Tool for Swallowing Recovery

While we often think of the benefits of healing arts interventions for mental health diagnoses, I recently came across an article that demonstrated the positive impacts of a music therapy intervention on physical functionality. Specifically, the study involved music therapy to address swallowing difficulties (dysphagia) in patients with head and neck cancer.

This small study included 15 patients in the intervention group and 13 in a control group. All study participants received standard conventional therapy for dysphagia. Additionally, the intervention group received 3 music therapy sessions per week for 4 weeks (a total of 12 sessions). The focus of the music therapy sessions were on a therapeutic singing intervention. Results demonstrated significant improvements in swallowing function in the intervention group as compared to the control group.

This study is fascinating, because while multiple studies demonstrate the positive impact of music therapy in addressing anxiety and depression in cancer patients, this study demonstrated improved functionality of physical symptoms. This prompted me to explore whether there were other studies also looking at therapeutic singing interventions to address swallowing difficulties in patients of a variety of underlying diagnosis. Here’s what I found:

Therapeutic Singing for Dysphagia in Advanced Stage Parkinson’s Disease (PD)

This small study looked at a 6-week therapeutic singing intervention to address swallowing function in advanced-stage PD patients. The intervention group of 8 individuals received twice weekly music therapy and conventional therapy sessions for 6 weeks. The control group of 9 individuals received twice weekly conventional therapy only for 6 weeks.

Results found that the intervention group maintained and preserved their swallowing function whereas the control group’s swallowing function declined over the course of the study period. This suggests that music therapy may help maintain and preserve swallowing function in advanced stage PD patients.

Music-Based Interventions to Address Aging-Related Swallowing Difficulties

This scoping review aimed to determine key intervention characteristics for music therapy as a tool to address age-related changes in swallowing function. Ten studies published between 2010 to 2022 met the inclusion criteria. Individuals in these studies were over 50 years old, and depending on the study, demonstrated swallowing impairments related to head and neck cancers, stroke, dementia, and other neurological impairments.

Studies employed interventions that addressed three key components of singing that involve muscles and mechanisms that are also vital to swallowing function:

1. Respiration

2. Vocalization

3. Singing

Specifically, key themes of the music therapy interventions included:

1. Warmup breathing

2. Vocalizing targeting laryngeal control

3. Singing targeting oral motor control

Similarly, the previous two studies mentioned in this article - addressing swallowing function in patients with Parkinson’s disease and those with head and neck cancers - used interventions that incorporated these components as well.

Implications for Swallowing Rehabilitation

These studies demonstrate that while there is a clear correlation in the impact of healing arts interventions to address mental health disorders, there is also evidence supporting the use of healing arts modalities as part of physical rehabilitation treatment plans - specifically therapeutic singing as an intervention to address swallowing function.

These studies offer a replicable framework for the structure of music therapy interventions to address swallowing mechanisms. This is an exciting path forward and avenue for further research as we continue to gather the scientific evidence in support of healing arts modalities and to further understand the pathways by which they create positive impact in patients’ lives and clinical outcomes.

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Resources:

Eseadi C, Ngwu MO. Significance of music therapy in treating depression and anxiety disorders among people with cancer. World J Clin Oncol. 2023 Feb 24;14(2):69-80. doi: 10.5306/wjco.v14.i2.69. PMID: 36908676; PMCID: PMC9993142.

Firmeza MA, Rodrigues AB, Melo GA, Aguiar MI, Cunha GH, Oliveira PP, Grangeiro AS. Control of anxiety through music in a head and neckoutpatient clinic: a randomized clinical trial. Rev Esc Enferm USP. 2017;51:e03201. Portuguese, Spanish, English. doi: 10.1590/s1980-220x2016030503201. Epub 2017 Mar 27. PMID: 28355317.

Jo S, Yeo MS, Shin YK, Shin KH, Kim SH, Kim HR, Kim SJ, Cho SR. Therapeutic Singing as a Swallowing Intervention in Head and Neck Cancer Patients With Dysphagia. Integr Cancer Ther. 2021 Jan-Dec;20:15347354211065040. doi: 10.1177/15347354211065040. PMID: 34903088; PMCID: PMC8679067.

Kim SJ, Yeo MS, Kim SY, Kang SY. A scoping review of music-based interventions for swallowing difficulties: implications for treating older adults with presbyphagia. Front Med (Lausanne). 2023 Nov 16;10:1285835. doi: 10.3389/fmed.2023.1285835. PMID: 38034547; PMCID: PMC10687455.

Rossetti A, Chadha M, Torres BN, Lee JK, Hylton D, Loewy JV, Harrison LB. The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy. Int J Radiat Oncol Biol Phys. 2017 Sep 1;99(1):103-110. doi: 10.1016/j.ijrobp.2017.05.003. Epub 2017 May 8. PMID: 28816136; PMCID: PMC7864375.

Xu Z, Liu C, Fan W, Li S, Li Y. Effect of music therapy on anxiety and depression in breast cancer patients: systematic review and meta-analysis. Sci Rep. 2024 Jul 17;14(1):16532. doi: 10.1038/s41598-024-66836-x. PMID: 39019965; PMCID: PMC11255342.

Yeo MS, Hwang J, Lee HK, Kim SJ, Cho SR. Therapeutic singing-induced swallowing exercise for dysphagia in advanced-stage Parkinson's disease. Front Neurol. 2024 Apr 2;15:1323703. doi: 10.3389/fneur.2024.1323703. PMID: 38628693; PMCID: PMC11018993.