Can Music Teach Us How to Talk? Music’s Role in Speech Therapy

Leo Mahlke

Illustrations by Racine Rieke

What is the first thing that comes to mind when you think of speech therapy? Maybe a child who says ‘thun’ instead of ‘sun.’ Perhaps you can imagine the child meeting with a speech-language pathologist (SLP) who guides them through repetitive drills and flashcards until their vocal fluency is improved. However, SLPs do much more than help with speech impediments; they work with people facing a diverse range of communication disorders and use a wide variety of treatment methods [1, 2, 3]. People with communication disorders can struggle to varying degrees with comprehending language, producing fluent speech, or communicating with others [1, 2]. While some are born with a communication disorder, others develop impaired language skills due to brain damage or age-related decline [4, 5]. Therefore, SLPs may work with anyone from premature babies with swallowing disorders to older adults with memory loss. To target the spectrum of needs for people with communication disorders, SLPs apply their broad expertise in neuroanatomy and physiology across diverse settings [4, 5]. Music is used as an innovative tool to support communication and language development [6, 7, 8]. Music activates brain regions associated with listening, moving, emotional processing, decision-making, prediction, and rhythm — all of which are essential for communication [9, 10, 11]. Engaging with music through activities like singing strengthens the relationship between auditory skills and motor responses, both of which are necessary for speech production [7, 12, 13]. Since the brain processes both music and language’s rhythms, melodies, and structures similarly, exposure to music can directly support language development [12, 14, 15]. The implementation of music into speech therapy can include playing lullabies for infants, rhythmic repetition of syllables, and group singing with elderly people [10, 12, 16, 17]. 

What Are Babies Babbling About?

As hierarchical systems, music and language are built from smaller units that come together to form larger structures [18]. Like beads strung together to make a necklace, syllables combine to form words and sentences, and musical notes combine to create songs [18]. Baby babbling, an early stage of vocal development, is a prime example of how the smallest hierarchical units of language and music are shared [19, 20, 21]. Early vocalizations like ‘bah’ or ‘gah’ combine the smallest subunits in the language and music hierarchical systems [19]. The shared hierarchical structure may explain why infants initially rely on similar parts of their brains to process both language and music [19, 21]. As we move up the hierarchical system from individual units to sentences or songs, specialized regions of the brain help us interpret their meanings [15, 18]. For example, Broca’s area, a neurological site of language processing and production, plays an important role in understanding the hierarchical systems of language and music [22, 23]. Broca’s area allows us to construct grammatically complex sentences and recognize nuanced musical patterns [22, 23]. 

Both music and language involve the brain perceiving, categorizing, and assigning meaning to sound [24, 25]. Sound identification and categorization depend on working memory, a form of short-term memory that allows people to retain and manipulate information even when absent from their immediate environment [26]. For example, if a child is taught and subsequently told to sing a new song, they use their working memory to remember the lyrics [26, 27]. Working memory also allows children to model their speech after those around them, so children with poor working memory are more likely to struggle with communication. If a parent prompts their child to repeat the word ‘Dada,’ a child with working memory deficits may struggle to remember and accurately repeat the sounds they just heard [26, 27]. 

Imagine how a sentence would sound if each word were one syllable and completely monotone. The sentence would feel flat and meaningless because no word would be particularly emphasized to convey the speaker’s intention [26]. Similarly, if every note in a song were the same, the song would feel repetitive and boring. When music and language lose their melody and rhythm, they also lose some of their contextual meaning [26]. Because language is inherently rhythmic, pairing speech with the sounds of a steady rhythm can enhance one’s grammar usage through a phenomenon known as the rhythmic priming effect [28, 29]. For example, when a child listens to music with a predictable and regular tempo, they show immediate — though momentary — improvements in grammar and syntax due to the changes in their brain wave activity [28, 29]. Brain waves are patterns of electrical activity created by groups of nerve cells in the brain [30]. While listening to a steady beat, a child’s brain waves that are associated with prediction, speech, and motor outputs synchronize with the beat, facilitating the anticipation and processing of language over time [15, 28, 29]. Suppose you are learning a new dance, such as the ‘Cha Cha Slide,’ and an instructor is calling out rhythmic verbal instructions, such as ‘slide to the left,’ that help you to follow along. The rhythmic cue provided by the instructor helps your brain to anticipate and synchronize the action it has to perform — in this case, a dance — with brain waves in the temporal lobe, a brain region linked to rhythmic auditory processing [15, 28, 29]. While the rhythmic priming effect can result in a brief improvement in communication, more research is needed to determine how long the benefits to speech and grammar last [15]. 

Infants who are exposed to music every day, both with and without lyrics, demonstrate a better ability to recognize and differentiate speech than infants without exposure to music every day [17, 31]. Listening to music can improve recognition of human speech fundamental frequency [17]. Human speech fundamental frequency refers to the vocal cord vibrations that produce sounds, interpreted as pitches in the temporal lobe. Recognizing speech fundamental frequency helps a baby differentiate between the sound of their mother’s soft, soothing voice and the low rumble of a radiator [17]. Listening to music trains the temporal lobe to predict future auditory patterns more accurately, which may improve speech processing [29, 31]. An increased ability to understand and differentiate between sounds helps a baby to better process speech, in turn supporting early language acquisition [17]. 

From Imitation to Articulation

Pediatric speech therapy can incorporate strategies from music therapy to foster language skills in children [7]. Young children’s brains are constantly developing as they are shaped by their interactions with the world around them [32]. As children learn, their brains exhibit neuroplasticity, a phenomenon that describes the dynamic restructuring of neural connections over time [32, 33]. Since neuroplasticity decreases with age, music is most effective at aiding in language acquisition early in life [34]. Incorporating music into early speech therapy could be particularly beneficial for children with communication disorders [7, 32]. SLPs might help children play with toy instruments, an activity that requires imitation and activates mirror neurons [9, 35]. Mirror neurons are cells that activate when someone copies an action they observe another person performing [31]. For example, if you watch someone yawn, your mirror neurons may also cause you to feel the urge to yawn [31]. If a therapist plays a toy drum and encourages the child to copy the action, the child’s mirror neurons are activated to imitate the therapist’s actions [9, 35]. When mirror neurons are engaged and strengthened through music, children may find it easier to imitate speech they observe in others [9, 35]. Furthermore, the auditory-motor feedback from hitting a drum and hearing its sound helps reinforce the connection between listening and coordinating muscle movements. Auditory-motor feedback is a process needed for speech production [9, 35]. SLPs can also musically engage a child through singing together [7]. An SLP may use songs where the child fills in missing words or repeats the therapist’s words. Simple and repetitive songs such as ‘Row, Row, Row Your Boat’ are suitable for speech therapy because the children will hear the same sounds and syllables repeated again and again at a slow tempo, helping the children better understand how words are structured [7]. Through rhythm, repetition, and shared engagement, music can support processes necessary for speech production, from imitation to articulation [7, 36].

Melody Meets Meaning

In addition to contributing to pediatric speech therapy, music can enhance language skills in adults [37]. Although adults exhibit less neuroplasticity than children, making it harder to learn new language skills, adults with communication disorders can also benefit from implementing music in speech therapy [10, 32]. When listening to your favorite song, you might feel happy, be tempted to dance, and even sing along. Without realizing it, you have used parts of your brain associated with emotion, small and large motor skills, speech, listening, and memory [37, 38]. Music helps adults with neurological damage build new networks of interconnected brain cells [37]. A person with damage to Broca’s area may struggle to produce speech, a condition known as non-fluent aphasia, but they often retain the ability to sing [10]. Music may strengthen the brain’s ability to find new neural networks to successfully produce speech without relying on the damaged Broca’s area, helping a person regain lost skills and facilitating remarkable recovery in those with non-fluent aphasia [10, 37]. 

Music can help adults who have suffered brain damage and lost language capabilities by gradually strengthening the relationship between rhythm and language [10, 11]. Melodic intonation therapy (MIT) involves a person copying syllables and words while tapping in sync to a rhythm and melody set by an SLP [10, 11].  MIT can improve the relationship between rhythm and language [10,11]. Using a gradual approach consisting of steps that slowly increase in difficulty, MIT starts with simple syllables and slowly progresses to full sentences [10, 11, 39]. Together, regular rhythm and melody facilitate speech production by strengthening the neural pathways in and between both brain hemispheres, which is especially beneficial if one side has undergone significant damage [39]. A person with a communication disorder may initially learn to say, ‘I am hungry,’ and, ‘I need you to help me,’ with help from an SLP, and eventually, they will be able to speak in fuller sentences without needing to follow the therapist’s rhythm or melody [11, 39]. MIT is especially helpful for adults — who are more likely than children to experience a stroke, dementia, Parkinson’s disease, and traumatic brain injury — because it helps the brain create new pathways around the damage [10, 11, 39].

Bridging the Gap: Speech, Autism, and Self-Advocacy

The use of music in speech therapy can enhance communication and self-advocacy skills for individuals with autism spectrum disorder (ASD) [40, 41]. ASD is a neurodevelopmental disorder characterized by repetitive behaviors and challenges with sensory regulation and social communication. Communication in individuals with ASD can range from nonverbal forms to verbal articulation [41, 42]. People with ASD face communication challenges because their brains have different levels of functional connectivity [42, 43, 44]. Functional connectivity (FC) is a metric that represents the dependent activation of one brain region on another [45]. Individuals with and without ASD have different levels of FC [42, 43, 44]. When FC deviates from the baseline level of an individual without ASD, speech deficits can occur [47]. Therefore, having both increased and decreased connectivity can be detrimental to an individual’s ability to communicate [42, 43, 47, 48]. For example, Broca’s area may struggle to communicate with a region associated with language comprehension called Wernicke’s area due to lower functional connectivity between regions [42, 43, 44].

SLPs can use music in therapy to help people with ASD communicate, advocate for themselves, and socially connect with others [42, 48, 49]. One approach SLPs can use to improve self-advocacy and communication is auditory-motor mapping training (AMMT) [48]. AMMT is based on MIT; however, during AMMT, an SLP taps electronic drums that are tuned to match the pitch of the word they are singing. The person with ASD then imitates their SLP by repeating the word and tapping the drum. AMMT synchronizes movement, hearing, and vocal skills: tapping the drum helps link the motor aspect of speaking with listening, which makes it easier to learn new words. Drumming, as used in AMMT, also encourages imitation skills, which can help activate mirror neurons [48]. Mirror neurons help every person, with or without ASD, understand emotions and intentions in conversation, processes that are often challenging for people with ASD [42, 50, 51]. Have you ever seen someone cry and subsequently felt their sadness yourself? Empathetic reactions to someone's emotions result from mirror neuron functioning, which encourages imitation [51]. People with ASD often struggle to detect and relate to the emotions of others as a result of reduced mirror neuron activity [42, 48, 52]. Social and emotional struggles can be a contributing factor to heightened levels of anxiety and social isolation in individuals with ASD compared to those without ASD [42, 50]. Using music therapy to promote mirror neuron activity for individuals with ASD may improve empathy and emotional understanding by strengthening mirror neurons in emotional contexts [42, 48, 52].

Music therapy can also help individuals with ASD become more motivated to speak and improve their ability to self-advocate [42]. In addition to aiding speech production, music therapy can facilitate socialization by activating the ventral tegmental area (VTA), which is a region of the brain associated with promoting reward-driven behaviors [53]. Activating the VTA triggers the release of dopamine, a chemical messenger that enhances learning, motivation, and the feeling of reward when tasks are accomplished [53, 54]. For example, listening to your favorite song stimulates your VTA, which triggers the release of dopamine, reinforcing the behavior and making you more likely to repeat it [53]. People with ASD may experience atypical development of the VTA, causing less dopamine to be released during social interactions, and music may be helpful to attenuate this underrelease [53]. Improving communication skills through music therapy also allows individuals with ASD to better advocate for their needs and preferences [49]. Rather than focusing on altering the traits associated with ASD, the goal of facilitating speech development is to empower individuals by equipping them with the tools to self-advocate. The ability to assert their own rights is crucial for people with ASD to receive the support they need [49]. 

Find Your Voice in Song

‘Finding the words I want to say is very hard, and my thoughts seem like they are blank,’ reports a person with Parkinson’s [55]. Parkinson’s, a neurological disorder characterized by slow movement, tremors, and cognitive decline, can cause communication impairments [11, 56]. Neurological damage to the motor cortex or other brain regions controlling respiration and articulation can lead to dysphonia and dysarthria [57, 58, 59]. Dysphonia causes a weakened and raspy vocal quality; dysarthria causes slurred and impaired speech [58, 59]. However, singing enhances the communication of people with Parkinson’s by supporting the neurological and physiological processes involved in speech [11, 13, 60]. Controlled vocal cord movement and respiration are essential for both speaking and singing, making singing a valuable tool for improving speech clarity, vocalizations, and facial muscle movements [11]. Therefore, singing in speech therapy may improve the vocalizations of someone with Parkinson’s from disjointed, slurred words into intelligible, smooth speech [12, 58, 59].

The communication difficulties caused by Parkinson’s can become isolating for the individual [55]. ‘My husband has lost his initiative in social situations. He listens but rarely contributes,’ describes the partner of someone with Parkinson’s [55]. Group singing is a therapeutic approach that can be used to address the disconnect that Parkinson’s can cause, as it improves the motor skills required for communication and brings people together [12, 13]. Together, people sing familiar songs like ‘Happy Birthday’ and participate in breathing exercises, vocal warm-ups, and rhythmic clapping [12]. Group singing strengthens the brain’s control over respiration, the vocal cords, and other muscles involved in speech production [13, 60, 61]. Singing involves highly coordinated movements that occur in an organized, sequential order [13]. For example, a person first regulates breath intake before singing a note, then adjusts the pressure in their vocal cords to create different volumes and pitches [61]. After producing the note, the brain has the task of coordinating audio input and output [13]. The brain synchronizes the sounds it receives with the right muscle movements necessary to sing the correct notes. For instance, when singing in a group, individuals will listen to the pitches and timing of those around them to remain synchronized with the group. The connection between the auditory and motor regions is stronger during group singing than when playing an instrument [13]. Compared to speaking, singing demands more respiratory support, louder and more sustained vocalization, greater variation in pitch, and more accentuated articulation [13, 60]. Therefore, group singing practice effectively targets the motor challenges faced by people with Parkinson’s. Many people with Parkinson’s struggle with dysphonia and dysarthria, so they benefit from the louder volume, improved clarity, and breath control promoted by group singing [13, 60]. Besides targeting motor skills, group singing also enhances neurological function [62]. Neural activation and connectivity increase when people sing, causing brain regions involved in movement and vocalization to become more active. Additionally, neuroplasticity heightens the temporal lobe’s ability to process auditory information, allowing singers to better modify their vocalizations [62]. 

Melodies for All: The Soundtrack to Healing

The implementation of music into speech therapy is a transdisciplinary approach, strengthening speech therapy by incorporating methods from music therapy [7]. Language processing is not localized to a single area of the brain such as Broca’s area [12, 22, 35]. Instead, language processing is distributed across a vast network of regions [13, 22, 32]. Language involves auditory processing, coordinating the muscles used for speech, and using cognitive skills to understand speech and form words [13, 22, 32, 35]. Because language skills depend on many different regions of the brain, implementing music in speech therapy can foster neuroplasticity by building alternative pathways for communication between brain regions [13, 32, 33]. Music has benefits for people with a wide range of communication disorders, such as engaging social and linguistic development in people with ASD and supporting vocal strength in people with PD [12, 13, 42]. Despite the benefits of integrating music into speech therapy, there are still obstacles impeding the widespread adoption of music as a speech therapy practice [7]. Training SLPs to utilize new methodologies or collaborate with music therapists is expensive and difficult to achieve in low-income communities [7]. In order to promote the use of music in speech therapy, music as a treatment for communication disorders must continue to be studied [7]. Music has the potential to be a powerful tool in speech therapy and has already had a positive impact on many people with communication disorders [9, 10, 11]. However, we will only be able to fully measure its potentially life-changing impact on people with communication disorders once this treatment becomes accessible to everyone who could benefit from it [7, 10, 11].

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