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. 2025 Jul 6;17(7):e87374.
doi: 10.7759/cureus.87374. eCollection 2025 Jul.

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

Christina V Oleson  1 , Samuel W Onusko  2 , Michelle S Djohan  2 , Mary J Roach  2 , Carol S Mizes  2 , Dwyer B Conklyn  2
Affiliations

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

Christina V Oleson et al. Cureus. .

Abstract

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.

Keywords: covid-19; diaphragmatic breathing; music therapy; post-acute sequelae of covid; respiration; therapeutic singing; vocal intonation therapy.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. MetroHealth Institutional Review Board issued approval 20-00570. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Participant inclusion flow diagram
NMT: neurologic music therapy
See this image and copyright information in PMC

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