The Effectiveness of Structured Neurologic Music Therapy on Phonation and Breathing Function Following COVID-19

Objective To analyze the effectiveness of neurologic music therapy (NMT), consisting of diaphragmatic breathing (DB), vocal intonation therapy (VIT), and therapeutic singing (TS), on sustained phonation and oxygen use during recovery from the recent coronavirus disease 2019 (COVID)-19 or post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) (PASC). Methods The study was designed as a retrospective cohort study. Sixty-nine adults admitted to acute inpatient rehabilitation with recent COVID-19 or PASC received standard physical, occupational, speech, and respiratory therapies. All were given a graded exhalation device with vibratory stimulation to help strengthen the muscles of expiration and clear secretions. Bronchodilators were administered as needed. Supplemental oxygen was prescribed to maintain saturations >92%. Thirty-three individuals also chose to receive NMT 1-3 times weekly for the duration of their inpatient rehabilitation hospitalization. The main outcome measures were changes in oxygen demand during rehabilitation and breath control, defined as sustained phonation (expiration) from a single breath. Secondary outcomes were discharge disposition and NMT participant experience. Results Compared with the non-NMT group, NMT participants required significantly more oxygen during activity at both admission (p=.010) and discharge (p=.007). Within the NMT group, significant improvement in oxygen demand was observed from admission to discharge, both at rest (.7833L reduction, p=.003) and during activity (.8500L reduction, p=.003). The degree of improvement in the need for oxygen also showed differences between the two groups. Compared with non-NMT participants, those receiving NMT demonstrated a significantly greater reduction in activity-based oxygen use during rehabilitation (p=.014, Cohen's d 2.06). Despite a longer duration in acute care than the non-NMT group, the NMT participants had an equivalent number of days in inpatient rehabilitation and a higher rate of home discharge (p=.018). Positive correlations were found in changes in phonation abilities, measured by the number of NMT sessions completed (p=.021) and by minutes of NMT received (p=.009). The majority of participants rated their experience with this program as positive. Discussion Proper DB with VIT and TS can have a meaningful effect on sustained phonation, breathing tolerance, and vocalization, resulting in participants reporting fewer pauses for air while speaking. NMT was considered a positive experience that also potentially contributed to the reduction in oxygen dependence after COVID-19.