It's not surprising to hear the sound of music at The Palms of Largo, a senior living campus in Largo, Florida. After all, most people enjoy music – whether it's for entertainment or recreation – and the residents of The Palms of Largo are no exception. Yet, many of them belong to a musical group called the Tremble Clefs for a completely different reason: to help with their Parkinson's symptoms.

The Tremble Clefs are a singing group that meets twice a month under the guidance of Leah, the Parkinson's and Stroke Support Group Facilitator at Cypress Palms (an assisted living community on the campus). With the help of speech-language pathologist Tiffany and pianist Bryan, their two-hour sessions mix music, therapy, and community.

How Music Helps

"I start with 15 minutes of stretching and breathing exercises," says Leah. "Then Tiffany leads the vocal exercises for the next 15-20 minutes. Some of it is a standard vocal warmup, but some of it is more like speech therapy since she is a speech therapist."

After that warmup, the Clefs take a 15-minute break for coffee, water, pastries and social time, and then they get down to the real business – singing. Bryan accompanies them every other session and records his music for them to take home for practice. Their binders have all of the song sheets and something equally important – a booklet from the American Parkinson Disease Association (APDA) on speaking effectively.  

"Parkinson's has a negative effect on the vocal cords, larynx, and muscles in the throat," Leah says. "The voice becomes softer and softer and hard to hear. We're trying to prevent that."

Research Proves It

If you think of singing as an exercise for those muscles, the connection seems obvious. But research shows that the benefits of singing together as a group actually go much deeper.

Researchers from Iowa State University studied the impact of singing on a small group of people with Parkinson's disease and found that it "improved respiratory control and muscle activity associated with swallowing in persons with Parkinson’s disease. Moreover, singing groups can be enjoyable for participants and offer a way to relieve stress, have fun, and improve other motor symptoms."

Besides the singing, Leah pays special attention to those other benefits. For example, the members swing American flags when they sing "God Bless America," and she bought bells for them to ring (and to choreograph more arm movements) when they sing Christmas carols.

Seeing the Benefits

There are 40 regular members of the group. One of them belonged to a barbershop quartet and a few others used to sing in choirs, but the rest had no real singing experience. "I think some of them are participating because their wives made them," Leah chuckles, "but some of them are definitely here for the health benefits."

In fact, a few of the members have seen impressive improvements.  "The Tremble Clefs have helped me tremendously with voice projection, enunciation, and self-esteem," says Robin, a resident at The Palms of Largo. "I’ve learned how to project my voice and enunciate so that others may hear me better," says Kevin, another member of the Tremble Clefs.

Leah proudly talks about two gentlemen who were extremely hard to understand prior to joining the group. "In the last six months, John's voice has gotten stronger and easier to understand," she says. "I don't need to put my hand to my ear to hear him anymore."

"And Fred's voice used to be so quiet, I could barely hear it," she adds. "But I was walking outside the other day, and somebody got my attention by saying, 'Hi Leah.' I turned around and couldn't believe it was Fred. He's made that much progress."

None of this happens by accident. Leah, who also runs the Rock Steady Boxing Program (another innovative group for individuals with Parkinson's), selects most of the songs for their therapeutic benefit. "God Bless America" is a good warmup, "What a Wonderful World" is more difficult, and then they sing "Somewhere Over the Rainbow."

"We chose the Israel Kamakawiwo'Ole version," she says, "because it has lots of peaks and valleys in the song. It really challenges them vocally." They also sing Neil Diamond's "Sweet Caroline," because Diamond has Parkinson's.

Looking to the Future

The group recently celebrated its first anniversary, and 16 Tremble Clefs members performed at the Parkinson's Foundation's Moving Day walk, about an hour-and-a-half away in Tampa. "After the walk was over, we were on the main stage. We all had matching shirts on and sang four songs. I was so proud."

Up next, Leah hopes to receive a grant from the Parkinson's Foundation to create a Tremble Clefs handbook. The program is loosely based on the original Tremble Clefs groups formed in California and Arizona, but there aren't any formal procedures or guidelines to follow. Leah would like to make it easier for groups across the nation to form and help people with Parkinson's. "Because music makes people happy," she explains. "We all know that."