Parkinsons Resource Center of Spokane

That’s what the members of the Spokane Tremble Clefs do every week when they assemble for about an hour of fun, vocal exercises and camaraderie.  In folks with Parkinson’s Disease (PD), the voice softens and loses its expression.  These speech problems are caused by incoordination or reduced movements of the muscles we use in breathing, voice, pronunciation and prosody (a ten dollar word for rhythm, intonation and speaking rate).  The Tremble Clefs is a nation-wide program of vocal exercises and singing designed to help those with PD and their caregivers lessen these symptoms.  An extremely important aspect of the Tremble Clefs is the strong social interaction, which encompasses sharing, encouragement and support for one another.

If you are not a singer, why should you join a singing group to improve your voice?  Speech-language pathologists have developed therapy programs specifically designed to address speech and vocal problems for those with PD.   While these programs are of proven effectiveness, they are generally one-on-one and are helpful in maintaining skills learned through speech therapy, specifically the Lee Silverman Voice Training program.  The Tremble Clefs adds the benefits associated with group interaction.  Additionally, the beneficial effects of music therapy on cognition, memory, movement and mood continue to be documented.  Dr. Oliver Sacks, a physician and professor of neurology and psychiatry at the Columbia University Medical Center, is the author of Musicophilia: Tales of Music and the Brain. He indicates that humans are a musical species and that music occupies more areas of the brain than does language.  The Institute for Music and Neurologic Function in New York uses music therapy for Alzheimer’s patients to improve cognition and memory.  Small groups of patients who may not recognize names and faces sing familiar songs from memory and they quickly learn unfamiliar songs.  A recent report from England told of a woman diagnosed with PD 14 years ago who stopped taking medications after six months because they affected her mobility and continence.  She found that singing and concentrating on a rhythm stopped her shaking and made her feel calmer.  While this may be a rare case and it is not recommended that you substitute singing for your PD medications, it is another example of the potential benefits to be gained from music and singing.

Speech-language pathologist Karen Hesley started the original Tremble Clefs group in Scottsdale, AZ in 1994.   The group’s name was proposed by one of the members, Ned Brooks, and is a play on words that may not be readily apparent to those who are musically challenged.   A musical score consists of an upper staff that begins with a “treble clef” signifying that the notes in that staff are a higher pitch.  The second or bottom staff of the score begins with a “bass clef” and it contains the lower pitch notes.  The support group is, therefore, rather appropriately named since it contains an element commonly associated with Parkinson’s folks (trembling) and another element common in musical notation (clefs).   However, absolutely no musical or singing ability is required in order to participate in the Tremble Clefs sessions.

Spokane speech-language pathologist Sara Nielsen met Karen Hesley at a Parkinson’s conference for healthcare professionals, including Speech-Language Pathologists, several years ago.  Karen had since moved to San Diego where she started another Tremble Clefs group.  When Sara heard how beneficial and how much fun the singing group was for participants, she was determined that Spokane should have one, too.  But Sara felt that she lacked the musical ability to direct a singing group and was hesitant to start one on her own.  As fate would have it, a Spokane neurologist who specialized in movement disorders knew Sara and had a new patient, Ruth Palnick, who had recently arrived from Arizona.  Ruth has Parkinson’s, an extraordinary amount of musical talent, a strong calling to help others, and knew of the Scottsdale Tremble Clefs.  The neurologist suggested that Sara and Ruth meet each other and the result was that they became co-directors of the Spokane branch of the Tremble Clefs.

The group started out in 2005 meeting twice each month with 4 members and grew to about 15 members two years later after media publicity in the local newspaper and in other publications. Currently, there are around 25 folks with PD on the roster.  Adding in partners/caregivers results in a potential pool of 40-45 participants, although most sessions have a group size of about 20.  Each one-hour session begins with about a 10-minute fun series of breathing, oral and vocal warm-ups designed to improve the volume, projection and quality of participants’ voices.

Tremble Clefs members doing warm-up stretching.

The warm-ups are followed by singing old favorite songs to the accompaniment of music played on a grand piano by Barbara Naff.  Barbara is a caregiver for one of our members and volunteers her time and talents, as do Sara and Ruth.  The lyrics are projected for all to see using a donated overhead projector and screen.   Projecting the lyrics, rather than having printed booklets of songs, is preferred because that makes it easier to maintain appropriate posture while singing.  The piano and room are provided free of charge by the Rockwood South Hill Health and Wellness Center.  Their personnel prepare the room for us in advance by setting up chairs, the projector and screen.  They also provide ice water, lemonade, drinking cups and, often, cookies for the group, also at no charge.  Water and lemonade are distributed to members about halfway through the session (but nobody gets a cookie until we’re done!).

Tremble Clefs intently concentrating on the projected lyrics.

Ruth’s neurologist told her that he could tell which of his PD patients were members of the Tremble Clefs because he noted an improvement in the volume and quality of their voices.  He suggested that the Tremble Clefs hold weekly sessions instead of just two a month.  Since the Tremble Clefs is an all-volunteer group, and since Sara and Ruth have jobs and other responsibilities and demands on their time, weekly sessions would only be possible if we could find one or more additional qualified volunteers to handle the speech therapy, music directing and piano accompaniment responsibilities.

In Spokane, Washington State University and Eastern Washington University offer a cooperative graduate program in Speech-Language Pathology.  They also operate a speech and hearing clinic where the students can receive hands-on-training in their profession.  Sara and Ruth met with Doreen Nicholas, the University Hearing and Speech Clinic director, to explore the possibility of having speech-language pathology students do practical community work with the Tremble Clefs during their first year of training.  Doreen was very enthusiastic about this opportunity for her students and in the fall of 2009 we began a pilot program with our first two graduate students.  As luck would have it, those two students were musically inclined and one even had formal training in piano and singing!  The weekly sessions were a resounding success for both the Tremble Clefs and for the students.

In January 2010, two different speech therapy students began working with the Tremble Clefs.  While they eagerly and willingly provide their knowledge of speech therapy, they do not have either musical directing or piano playing capabilities.  At the present time, Barbara, our regular accompanist for the twice a month sessions, is playing the piano every week.  We are in the process of exploring possibilities, perhaps students in musical programs at local institutions of higher learning, to fill the gaps in directing the singing and in piano accompaniment.

In addition to the weekly sessions, the Tremble Clefs give concerts at senior centers and assisted living facilities on occasion.  In 2009, the Tremble Clefs performed for the first time at the Spokane Street Music event.  In this event, instrumentalists and singers, individually or in groups, are assigned a location on Main Street where they perform during the lunch hour.  Each performing unit has a bucket into which passersby can drop donations that go to the local food bank.  Besides the fun of singing in public, this event was an excellent workout for the Tremble Clefs voices because their assigned location was across the street from an oom-pah band and a building that was undergoing major renovation, not to mention the usual downtown street traffic noise.  Passersby apparently liked the performance because our bucket was full of donations for the food bank!  The final performance for each year is a program of holiday music presented at the December Telehealth event.

Tremble Clefs Entertaining During Street Music Week in Spokane, WA

The Spokane Tremble Clefs is a vital, vibrant organization celebrating its 5^th anniversary this year.  Recently, a number of the members were asked why they joined the group and why they keep coming back.  Just about everyone said they joined to address the soft voice symptoms of PD.  Judging by reports from family members and caregivers, the program has improved their voices.  However, when asked about the reasons for coming back, the responses include terms like camaraderie, friendship, inspiration and fun.  Each session is a mood elevator and that is apparent from the animated expressions on the faces of participants at the end of the sessions.

The Tremble Clefs operate as a support group under the Parkinson’s Resource Center of Spokane (PRC).   If you would like information about joining the Spokane Tremble Clefs, or about forming your own group, you can contact me through the PRC at 509-473-2490, email center@spokaneparkinsons.org, or you can contact me directly at waltjay@yahoo.com.  If you are interested in forming your own group, an excellent source of information, including a guide detailing the key elements that should be addressed, can be found on the website http://trembleclefs.com.

So, would you like to improve your voice?  Would you like to make new friends and elevate your mood?  Would you like to have fun?  If you said “Yes” to any of these questions, then join or start a Tremble Clefs group and make a joyful noise by singing—singing out LOUD!

Walter Jakubowski serves on the Board of Directors for the Parkinson’s Resource  Center of Spokane.