Ep. 026 | Parkinson’s Disease and Music Therapy

Today, we chat with guest, Megumi Azekawa, a board-certified music therapist, about her work and how singing can benefit individuals with Parkinson's Disease.

RESOURCES

Sound Health: Singing for Parkinson's Disease by Jessica Frost | Online Article

Music Therapy and its Impact on the Brain by Dr. Elizabeth Stegemoller | TedTalk

Azekawa, M. & LaGasse, A.B. (2017). Singing Exercises for Speech and Vocal Abilities in Individuals with Hypokinetic Dysarthria: A Feasibility Study. Music Therapy Perspectives, 36(1), 40-49.

TRANSCRIPT

Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and today, we are talking about Parkinson’s disease and music therapy, with Megumi Azekowa. Megumi is a board-certified music therapist and Neurologic Music Therapy Fellow in Takoma, Washington. She is the founder and director of Puget Sound Music Therapy, offering high quality, evidence-based music therapy services consultation in a wide variety of settings. She is also a co-chair of the Washington State Music Therapy Task Force, a group working to seek state recognition of the music therapy profession, in order to increase professional music therapy services for all Washington residents.

[Podcast intro music plays]

Erica: Welcome, Megumi, to the podcast Thanks for joining us today!

Megumi: Thank you for having me.

Erica: Absolutely! So, I’m really excited to talk to you. Today’s episode is all about music therapy and Parkinson’s and the intersection with neurologic music therapy —

Megumi: Mmhmm —

Erica: Which is something that you’re expertly trained in how to do.

[Megumi chuckles]

Erica: But also, Parkinson’s, for me, is a little bit more personal than the other episodes that we’ve done because my dad has Parkinson’s. So I am more intimately aware of like what that means and what the impact of that is - and all the different things. So I maybe have some questions that are a little bit more nuanced than usual —

Megumi: ‘Kay.

Erica: So, let’s just jump right in to get us started. Can you tell us about how did you originally get into music therapy? How did you decide to become a music therapist? All that good stuff.

Megumi: All the good stuff. Yeah, so it goes back to around 16 years ago. So I was a CNA in a dementia unit on a assisted living in Bellingham back then. One day I was about to help a client for bathing - and before bathing, I was trying to help her for going to toilet. But she was not able to do, and um I was trying to help her as best as I can by explaining verbally and, you know, little demonstration of the each step - but she was almost nonverbal and didn’t respond much. And somehow, I started to hum the song “Side by Side” - the folksong - probably I subconsciously thought to ease the mood for myself and for the client. And next, what happened was that she was able to sing the complete 2 verses of the song without my help. And then after that, she was able to follow my directions for bathing with my assistance, and went to bed soundly afterwards. And I was like, what was that? And it was my goose bump music therapy moment.

I started seriously pursuing music therapy as my career. So I went to University of Washington to complete my saxophone study. Then, during that time, I was fortunate to be able to do the independent study about music therapy because couple of the music education professors there were knowledgeable and helpful for me to prepare for applying to the graduate school in music therapy. And I started studying music therapy at Colorado State University shortly after that. And here I am.

Erica: Very cool. Has music always been a part of your life in growing up and just doing everyday life?

Megumi: Yeah. Yeah, um, I’m originally from Japan, and I started playing the piano when I was 5. And usually, in Japan - at least back then - band starts around junior high or middle school time. So I started playing since 7th grade for the saxophone. And yeah, I played the saxophone even after I graduated with my, you know, um classmates or schoolmates - and we actually went to contests and had little gigs - played semiprofessionally while I was doing different, totally nonmusic-related jobs.

Erica: Mmm.

Megumi: Yeah, so. Yeah. Music has been a tool for me to connect with so many different things.

Erica: That’s awesome, I love that. So, how did you start working with Parkinson’s patients?

Megumi: So, my involvement with Parkinson’s community began - so 13 years ago? While I was a graduate student at Colorado State University. So there was a Parkinson’s exercise group going on with a music therapist, who I eventually studied under for my internship. She came to our campus with her colleague, a physical therapist, to provide weekly groups, specifically for uh people with Parkinson’s - for their motor coordination, strength, balance, and such. And I was a student there - going there - helping the group. Then I got to know how to interact with them in a professional manner, and I observed their resilience and willingness to work hard, despite the challenges of Parkinson’s - that really inspired me. And that encouraged me to create the best possible music therapy template interventions. And that lead me to conducting a graduate research project that uses the vocal and singing exercises for people with Parkinson’s. And, I came back... 7 years ago?

Erica: Mmm —

Megumi: Wow, time flies —

[Erica laughs]

Megumi: I just cannot [laughing] keep track. Anyway, so I was doing that group - so the research project became a regular weekly group afterwards.

Erica: Mmm.

Megumi: Um, because there was the physical exercise group, and then we kinda, you know, targeting back to back for 2-hour session in the end. SO I was doing that until I left there. And then we came back and I connected to a support group in this area - and the support group leaders around this area were so helpful and then being interested in learning more about music therapy. So I got to connect with the Parkinson foundations around here.

Erica: Mmm.

Megumi: We have 2 amazing organizations in Seattle —

Erica: Yeah —

Megumi: Um, yeah. I got to get connected with both of them, and I was able to start the music therapy for Parkinson’s group 5 years ago?

Erica: Okay! Very cool.

Megumi: Yeah, so that’s how I started in Washington.

Erica: Yeah, awesome.

Megumi: Yeah.

Erica: I’m curious - like, um, is there a mental health component to what you’re doing with the Parkinson’s groups? Are you - or are you pretty focused on the physicality and those symptoms of Parkinson’s?

Megumi: So, I’m aware that a lot of the client that I’ve interacted with have had some mental health needs to address. But for groups, per say, that I’m doing, we’re specifically addressing the vocal and speech needs of their —

Erica: Mmm —

Megumi: Yeah, or physical needs. So, that’s kind of a secondary outcome - that they feel a little bit more motivated, or feel a little bit more connected, therefore lesser symptoms or feeling about feeling about down or depressed type of things happening. But I haven’t addressed in the group sessions —

Erica: Mmm —

Megumi: About mental health needs specifically. However, in my private practice, I see individual clients. Then, if that - they come because I have depression due to Parkinson’s, let’s say —

Erica: Yeah —

Megumi: For example, then I’m able to address that.

Erica: Sure.

Megumi: Yeah.

Erica: Yeah. So, what kind of activities or interventions could you expect - if a Parkinson’s patient was coming to a group or working with a music therapist, could you generalize on maybe like what a session might practically look like?

Megumi: My group sessions are really um organized with a protocol. So I made a singing and vocal exercise protocol out of my research, and I use that protocol. So, we usually do a warmup so that we can use the oral-motor more efficiently and effectively. And then. And then we do um vocal volume exercises. And we do a lot of warmups, but it’s not just adapting choir exercises. I worked with a speech therapist in the past and talked amongst ourselves and decided what target, by specifically using what exercise —

Erica: Mmm —

Megumi: That, you know, usually - you know, customized. So, for example - so I usually start with “Witch Doctor”. So if I go to - if you come to a presentation about Parkinson’s, I tend to start with that song.

Erica: Okay.

Megumi: And the chorus of the “Witch Doctor”, you know [sings] ooo eee ooo ah ah ting tang walla walla bing bang. So that gibberish [chuckles] it’s not even uh like uh —

Erica: It’s just random syllables —

Megumi: Random syllables, right —

Erica: Yeah —

Megumi: But it really helps us to easily exaggerate our oral-motor movement. So it’s like warming up our - like stretching our like big limbs —

Erica: Mmm —

Megumi: But it’s speech area, or oral-motor area. So - I know this is a podcast, you can’t see —

Erica: Yeah —

Megumi: But, [sings ‘ooo’] and then you kinda smooch your lips. And [sings ‘eee’] to pull out and [sings ‘ooo ah ah’] and ah, it’s really tall and loud, you know, longer. And [sings ‘ting tang walla walla bing bang’]. And I start slowly and gradually speed up - and then we usually do it 5-6 times in a row like that.

Erica: Okay.

Megumi: And we also do humming exercise, because when we are humming, our vocal cords are in a really um neutral zone - it’s not too separated or too close. So it’s a really gentle way to create this voice - vocal sound. And then, series of vo - vo - sorry - vocal warmups. And after that, we will sing songs - but not just singing and caring about the musical product, which is not the main concern, especially for my group - it’s about we uh clinically, carefully select the repertoire uh so that the rhythm helps to enunciate the sound of the words - phrasing better, or more efficiently. And, like, for example [sings] I love you a bushel and a peck. And like, it’s really rhythm helps to enunciate, but it’s not losing the beauty of the song either by slowing too much either. Yeah, so we do articulation control exercises.

And those are things - are why targeted is because people with Parkinson’s tend to develop a thing called hypokinetic dysarthria over the course of the disease —

Erica: Say that again?

Megumi: Hypokinetic dysarthria.

Erica: And what does that mean?

[Erica and Megumi chuckle]

Megumi: Right? Okay. Well, I would just tell you the symptoms —

Erica: Okay —

Megumi: Is the lower - lowering the muscle tone for the speech functions - vocal functions, so that it affects breath control. Or, you know, the speech sound carries different pitches - we’re not speak talking, but it has a inflection called prosody.

Erica: Mmm.

Megumi: That carries the meaning of the sentences. SO, if you don’t have those things in tact, even if we were speaking grammatically correct, it’s hard for listener to understand what they’re saying.

Erica: Absolutely.

Megumi: Right.

Erica: Yeah.

Megumi: So the prosody is little bit off - uh, becomes off - and so becomes monotone pitch way of talking, or hoarse voices - so the voice quality gets little bit affected - and consonant articulation gets a little affected as well. So it’s little bit harder for listener to hear what - or understand what they’re trying to pronounce.

Erica: Sure.

Megumi: Um, so those are the things that tend to happen. Um, so we use specific songs to target exercising articulation control. And also, we exercise the breath support by choosing song that has a symmetrical phrasing pattern, so that, you know, anticipation will happen at the same timing of each - the ending of each phrase.

Erica: Mmm.

Megumi: So we can strategically breathe, and we can breathe deeper - taking enough time. SO we exercise those kinds of things through singing.

Erica: Yeah. So that means that like a song would have a repeating like binary pattern? An A, B, A, B pattern —

Megumi: No —

Erica: So it could be predicted? Is that what you’re —?

Megumi: It could be, but my - the way I was trying to explain was - for example, I was thinking what song is the best one? So uh, do you know “Water is Wide?”

Erica: No.

Megumi: [Sings] The water is wide I cannot cross o’er / and neither have I wings to fly. So it - it’s like [count sings] 1, 2, 3, 4, [elongates] 5. It’s a phrase of 8 beats —

Erica: Oh, okay —

Megumi: After 5 to 8, it’s holding.

Erica: Mmm.

Megumi: The pattern of the song. Stuff like that, like, how about - I don’t know if I remember all the words, but um, Hank Williams “Your Cheating Heart”. I started in Colorado, so it’s a lot of country songs I used to sing.

[Erica and Megumi chuckle]

Megumi:  [sings] Your cheating heart  will make you weep. It’s kinda similar things. So it’s a 8-beat phrasing pattern —

Erica: Mmm —

Megumi: 8-beat phrase. But 1, 2, 3, 4 [elongates] 5. Breathe. 1, 2, 3, 4 [elongates] 5. Breathe. Kinda pattern. And —

Erica: Sure —

Megumi: Yeah, music is highly structured art medium - probably you know that because —

Erica: Yeah —

Megumi: You work with a bunch of music therapists [chuckles].

Erica: [Chuckles] Yes.

Megumi: So um, when we can anticipate an action to perform, of course we will do better, right. So, music naturally create that template for people who are exercising a target thing.

Erica: Mmm.

Megumi: So, yeah, it could be articulation exercise the same way - movement exercise of course. Uh, it’s a little bit different, but if you have a structure to anticipate, people with a mental health need can be using that aspect the music can be provide uh to —

Erica: Yeah —

Megumi: Yeah. So, rhythm and other musical elements create the anticipation and create the really stable and predictability. That’s the base, and I think that’s what I get most out of learning and knowing how to use Neurologic Music Therapy.

Erica: Yeah.

Megumi: Yeah.

Erica: So, let’s pause on that for a second. We’re drawing on this term Neurologic Music Therapy  - and so if you’re not in the community, you’re not likely to know what we’re talking about.

[Megumi chuckles].

Erica: So, can we talk about what is neurologic music therapy? And then how does that support your work —?

Megumi: So, yeah —

Erica: With Parkinson’s?

Megumi: Yeah., uh, Neurologic Music Therapy is um additional advanced training for music therapists. And basically talking about how music is processed in the brain, therefore, that processing will positively alter your behaviors or emotion regulation.

Erica: Mmm.

Megumi: And this happened in the ‘90s I think. Doctor Michael Thaut, now in University of Toronto, but back then in Colorado State University, with his colleague researchers, found that rhythmic cues help to coordinate the motor movements. And he systematized with um techniques names over 3 domains: uh, one for sensory-moto - so talking about motor movements - and the other for the speech and language, and then the last one is cognitive - so attention, memory, and executive functioning. It’s really highly evidence - evidence-based, so, core is - NMT for short is a therapeutic application of music, consisting of a set of standardized technique - and those techniques are established based on the findings of music and neuroscience research - and used to address clinical goals due to neurological conditions. So, therefore, I use for people with Parkinson’s, I often work with people with traumatic brain injury, stroke patients, multiple sclerosis - uh, also neurodevelopmental conditions, such as autism.

Erica: Mmm.

Megumi: Um, yeah. I worked um numorous clients who have autism. Yeah, so, it is a broad application of music therapy techniques, but it’s based on the research about how music works for the brain.

Erica: Sure. And that makes total sense, given that Parkinson’s —

Megumi: Yeah —

Erica: Specifically is a neurologic disorder.

Megumi: Yeah.

Erica: Um, so if somebody from the Parkinson’s community wanted to seek out a music therapist, we would highly recommend anybody with an NMT —

Megumi: Oh yeah —

Erica: Attached to their profession, because that means that they have this additional training beyond the basic certification that a music therapist needs. Also, as a quick side note, for anybody listening, if you’re looking for a music therapist, look for somebody that has an MT-BC, because that means that they’re board certified, which, in previous episodes, we have talked about quite a bit at length - I won’t go on a whole soap box about that. But, an additional credential would be an NMT. But um —

Megumi: Yes. I can talk about that MT-BC credential thing, as well you know, Erica, right? [Chuckles]

Erica: [Chuckling] Yes. Yes, right. Yes.

Megumi: I think the way you said is just totally cool. Just because I had - not to me, you know, music therapists without NMTs can treat people with Parkinson’s no problem. But with an NMT background, it’s obvious that wee have a little bit more understanding. But yeah, we have additional and advanced knowledge.

Erica: Yeah, absolutely.

Megumi: Yeah.

Erica: Yeah. As a music therapist, what are some ways that the Parkinson’s community can music at home for their own personal support?

Megumi: Sing. Singing is the easiest, non-cost, best possible things that I highly support - for anybody to use with any conditions - unless, you know, you have some strain on the vocal —

Erica: Mmm —

Megumi: Functions. What the reason is singing is a whole-brain workout. So, first of al, when we sing, we breathe more deeply than when we are talking, therefore, we are naturally sending oxygen to the brain, therefore, the body - so we can think better, move better, feel better, right. And of course, it’s free [chuckles]. Right. And, if you are systematizing to use, like with music therapy sessions, but uh even at home, if you are to see the lyrics sheet and sing, you are using different functions - you are tapping into the memory, attending to the probably recording - if you are singing along with a recording - and looking at the sheet to follow the words - and stuff like that. So you are activating so many different parts of the brain just by doing so. And again, it’s a feelgood activity to do. Yeah, so singing is one thing. And I actually have - usually provide some home exercise CD for my group folks —

Erica: Mmm —

Megumi: When they come. And I’m in process of making that available to download from website.

Erica: That would be cool!

Megumi: Yeah. But [laughs] I’m just so procrastinating - just so busy. Anyway, so once that’s available, I’ll let you know.

Erica: Okay, that’d be great. Yeah, I’d love to help make that available to people.

Megumi: Yeah. And probably a lot of people do this, but just make sure that you have your own playlist to listen to. So, the - the why I emphasize this point is that the research supports that the anticipating to listen to your preferred music actually can produce more dopamine.

Erica: Really?

Megumi: Yeah. SO, you know, in times of COVID-19 - the time we are at home is much longer, and sometimes it’s just hard to keep the routine going, or even refreshing of things - even small amounts. So, creating a rhythm in your daily life by listening to the music that you like is good to - a good way to use.

Erica: I love that. That’s awesome. I’m gonna tell my dad to listen to his music more.

Megumi: Yeah, and then through - yeah! And then through that, like just you said, it might create more connections amongst loved ones.

Erica: Mmhmm.

Megumi: And Visit your memories, and, you know, just create so many warm environment.

Erica: Yeah.

Megumi: Yeah!

Erica: Great! Well, I think singing - listening to music - are very accessible ways of making music. And I’ve said this before - and our team says this over and over and over - you do not have to be a virtuoso - you do not have to be the next great opera singer - you don’t have to carry a tune —

Megumi: Yeah —

Erica: To experience the benefits of making music.

Megumi: Correct.

Erica: Um, make music in all of its forms. If you don’t wanna do it publicly, go in your bedroom - do it by yourself. It’s still good for you.

Megumi: Absolutely.

Erica: Okay. So, for people wanting to know more about music therapy with Parkinson’ss what resources can we make available to them? We link them in our episode notes and on our website.

Megumi: M’kay. So, it was really timely article came up on a website - so uh Doctor Elizabeth Stegemoller - she is a board-certified music therapist and also a neuroscientist.

Erica: Oh!

Megumi: She’s a professor - yeah - at Iowa State University. Um, she has a TED Talk links and also um she just had a website article talking about her doing online virtual choir for people with Parkinson’s. So I will send that links to you.

Erica: Yeah. That’s really cool - how awesome that it came out right as we’re recording this.

Megumi: [Chuckles] And um, I did graduate research and that became published in Music Therapy Perspectives. And, again, I’m working on my website to be revamped, and then I’l make a link so that everybody can download —

Erica: Okay —

Megumi: But it’s not there yet.

Erica: Okay.

Megumi: SO in the mean time, if anybody’s interested in, you know, reading about my article, then I’m happy to email upon request. SO…

Erica: Absolutely. And what we’ll do, for people listening, is if you would like access to Megumi’s article, just email us at S as in Sam, C as in Cat, Music Project dot org (scmusicproject.org) and I will forward you on to Megumi, because I have Megumi’s contact information.

Megumi: Ah, good.

Erica: And then you can chat we her at length about whatever you want to chat with her about.

Megumi: And 2 other things that you’re - I mean, Erica, you know - we have 2 amazing Parkinson’s organizations in Seattle. One is APDA Northwest chapter - so American Parkinson’s Disease Association Northwest chapter. And the other one is Northwest Parkinson’s Foundation. Uh, their websites are full of information. And APDA Northwest e-newsletters I just found recently that there was a link to register a virtual choir called Sing Loud.

Erica: Really? That’s cool.

Megumi: It’s coming up like towards the end of this week. But I don’t think it’s just one-time thing. And, you know, they are very up to date with everything - very supportive. I worked with both of them and very impressed with their knowledge and, you know. Yeah, so that’s uh to go to. I mean, there are so - couple other uh big websites or foundations, like Davis Phiney and Michael J. Fox and other things.

Erica: Yeah.

Megumi: Yeah, I just highly recommend these are local.

Erica: Yeah, absolutely to the Northwest. My family has really benefited from the programs at the Northwest —

Megumi: Yeah —

Erica: Parkinson’s Foundation has put together.

Megumi: Yes.

Erica: Um, and so I highly personally recommend them - and I’ve worked with their team —

Megumi: Mmhmm —

Erica: A little bit on community relations and etc. They’re really great people. Yeah.

Megumi: Yes they are.

Erica: Awesome. Yeah, well, thank you, Megumi, so much —

Megumi: Well, thank you, Erica —

Erica: For being here and chatting, and —

Megumi: Yes.

Erica: It was great. Um, so, listeners, here’s all the things. If you want to know more about the Snohomish County Music Project, um or music therapy in Snohomish County or in Everett area, our website is S as in Sam, C as in Cat, Music Project dot org (scmusicproject.org). You can also find us on all major social media channels. Stay tuned for upcoming episodes - make sure you subscribe to the podcast and leave us a review. A review helps us just spread the word about music therapy - help people have a better understanding of what music therapy is, and how it can help them, help their family members - help their friends - etc. Um, just, thank you so much for listening, and we’ll talk to you next time.

[Podcast outro music plays]