Why singing in a therapeutic choir can help people with brain conditions

Imagine what it feels like to lose the ability to talk easily with friends and family. Brain conditions can affect speech, language, voice and memory. It might be a sudden event like a stroke, or a traumatic brain injury. It could be a degenerative condition like Parkinson’s or dementia. Struggling to talk makes life harder, and those affected can become very isolated .

For people living with these brain conditions, singing can unlock benefits that support recovery, connection and wellbeing. I’m a music therapist and in 2009 I co-founded a choir at the University of Auckland’s Centre for Brain Research. Members of the CeleBRation Choir sing together weekly for fun, friendship and to work on their communication. The choir has people of all ages, from their 20s to their 90s, and we tailor warm-ups, exercises and the song repertoire to the group. Even though members have diverse musical preferences, they will have a go at most songs. The success of this approach inspired my PhD research into what makes therapeutic choirs work and how they can be established and sustained.

Early research with the CeleBRation Choir found that people with a range of neurological challenges valued coming together to support one another. This inclusive “neurological choir” approach is unusual. Overseas, you’re more likely to find separate aphasia, Parkinson’s or dementia choirs.

People with different brain conditions face different challenges, but singing can help because music uses many parts of the brain simultaneously and the same vocal anatomy as speech. Stroke survivors often develop aphasia, a language disorder making it hard to find the right words or to understand others. Depending on the type of stroke, some people can sing more fluently than they speak. Others can vocalise and practise sounds and words through song. People with Parkinson’s often develop shallow breathing and quiet, unclear speech. But singing can help slow this progression by working on breath control, articulation and voice projection. For people with dementia, memory loss can seem less apparent when they are singing familiar songs that evoke vivid memories and emotions.

The social focus is a key element of therapeutic choirs. Music brings people together in a pleasurable activity. Although they may be anxious about singing, the group always offers a warm welcome and support. Group singing can reduce cortisol, a stress hormone, and increase mood-boosting endorphins. Music can also strengthen cultural connections and create opportunities to share across cultures.

Difficulty with conversation affects not only the individual person, but also their family, friends, and community. Some members prefer to join the CeleBRation Choir independently, but partners, whānau and carers are also welcome. The choir also sings regularly in care homes and retirement villages, encouraging audience participation rather than focusing on performance.

My research involved audiovisual analysis of these choir sessions and led to me developing the VOCCAL Handbook, a resource to encourage people to launch choirs. (VOCCAL is an acronym created from each section of the book.)

The framework was refined through focus groups with local and international music therapists as well as speech-language therapists. Interviews with choir participants and volunteers provided further insights into the enablers and barriers to choir and life participation. Online formats were also considered, building on experiences during the Covid-19 pandemic lockdowns. 

The handbook aims to give local people input into how their choir is set up. It also recognises that choir facilitators may have different skills, knowledge and further training needs. Music therapists can either lead groups or be called on for expert advice. The ideal is collaboration between practitioners, communities, agencies and funders, so more people can experience the joy and benefits of lifting their voices together.

The CeleBRation Choir has inspired the formation of other choirs across New Zealand. In 2017, I established Sing Up Rodney in Orewa, north of Auckland, and other choirs have now been established in Canterbury, Wellington, Bay of Plenty and Hamilton. They are led by music therapists, other professionals or community members. When people come together to sing, the benefits resonate far beyond the music.