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Memory Games & Hearing Voices

Memory Games & Hearing Voices

Investigating a common voice disorder and helping older adults with dementia

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Mentored by OT Clinical Associate Professor Sue Berger (left), Clare M. Brabson (’16,’18) provided a series of activities to help people with dementia at Upham’s Elder Service Plan in Boston.

It’s just about the most serene version of volleyball ever. There’s no diving to the floor, no aggressive spiking or jump serving. Balloon volleyball won’t become an Olympic sport anytime soon, but a group of older adults amiably batting balloons back and forth at a Boston care center might be the most heartwarming sporting matchup of the year.

Balloon volleyball is more than a fun diversion. Many of the players have dementia, and engaging in a sport—even a sedate one—could help slow their mental decline. According to the Alzheimer’s Society, physical activity could benefit people at all stages of the condition, from helping to stall loss of cognitive function to boosting social interaction.

The volleyball game was organized by occupational therapy graduate student Clare M. Brabson (’16,’18), who spent a year working with Upham’s Elder Service Plan, a Boston-based care program for older adults. Brabson provided a regular series of physical, cognitive, and sensory activities for people with dementia. Three days a week, she’d visit Upham’s Dudley Square health center to get a group of about six participants moving their bodies, exercising their brains, and testing their sensory skills.

“I was very excited when I started; I had planned all these groups and thought, everyone’s going to love it,” says Brabson. “They’re not used to many activities—beyond crafts—being offered, so coming in as this young student saying ‘Let’s go play some balloon volleyball’ made them a bit hesitant at first.”

“Sensory activities are very important for people with dementia, and can be good for their memory, overall stimulation, and interaction with an environment.”

—Clare Brabson

As Brabson built a rapport with the participants, more began to show up to her sessions, gamely trying beach ball tennis or musical instrument bingo. Now, even when Brabson swings by to check in, she says, someone will ask, “Oh, are you doing a group today?” Whether she’d planned to or not, she’ll run an informal activity.

Brabson scoured research papers and occupational therapy blogs for inspiration, studying the common challenges faced by people with dementia and developing activities to address them. One favorite was a tactile matching game, for which she glued lace, felt, cotton, and other textured items to ordinary drink coasters. Players flipped them over one by one in a quest to hunt down matching textures. “Sensory activities are very important for people with dementia, and can be good for their memory, overall stimulation, and interaction with an environment,” she says.

Brabson also turned to her academic mentor, Sue Berger, a clinical associate professor of occupational therapy, for guidance. “Sue’s background and many years of clinical experience working with older adults have been a great resource,” says Brabson. Berger also provided tips from her own 35 years in practice.

“Although Clare had excellent on-site mentoring and I provided support, as needed, she really took the initiative to develop some activities specific to the needs of the individuals at this site,” says Berger. She adds that Brabson also brought occupational therapists from Upham’s Programs of All-Inclusive Care for the Elderly (PACE) to Sargent to talk with students about their complete care approach, where doctors, social workers, nutritionists, and therapists all work alongside each other.

“[Clare] really took the initiative to develop some activities specific to the needs of the individuals at this site.”

—Sue Berger

The work at Upham’s was supported by an Albert Schweitzer Fellowship, a program for graduate students carrying out community service projects that target health disparities. The neighborhoods around Dudley Square, where Brabson worked, have some of the highest rates of premature deaths, low birth weights, diabetes, and poverty in Boston. Schweitzer fellows—there are just 15 annually in the organization’s Boston chapter—are given a $2,000 stipend to help fund 200 hours of service work; they also submit monthly reports, attend regular meetings with other fellows, and participate in community service outings.

Brabson will complete her degree with two internships—at Torit Montessori School and then Spaulding Rehabilitation Hospital, both in Boston—but she’s leaving the center with detailed guides to running her activities.

“My takeaway is that while I can’t change the whole world right now,” says Brabson, “I do have the power to change the world of some individuals; I did have a positive impact on the seniors at Upham’s.”


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Mentored by SLHS Assistant Professor Cara Stepp (right), Liz Heller Murray (’18) initiated a series of experiments designed to zero in on the cause of vocal nodules in children and help prevent them from forming.

If happiness had a sound, this might be it: yelling, screaming, squealing children on the playground. Kids make a racket. For many years, doctors thought all that hollering was responsible for vocal nodules, callus-like growths on the vocal folds. One of the most common voice disorders in children, vocal nodules cause persistent hoarseness that can make speaking difficult and exhausting, and undermine kids’ confidence.

To prevent nodules from forming, doctors often advise their young patients to talk less—a counterproductive prescription, as children need practice when developing language and speech skills. Researchers like Liz Heller Murray (’18), a doctoral candidate studying pediatric voice disorders at Sargent, are rethinking the cause of these nodules. Heller Murray believes the problem may originate in the brain, not the voice.

The vocal folds (popularly known as vocal cords) are the soft tissue on top of the windpipe. They snap shut to keep food from traveling down the “wrong pipe,” and when they vibrate, they make the sounds we use for speech. When the folds slam together too hard, too frequently, or with too much effort, hard white nodules can build up where they meet.

“[Not all children are] going to be actors and singers, but you want them to be able to give a book report without getting hoarse.”

—Liz Heller Murray

Researchers study vocal nodules by taking videos of them with a nasal endoscope, a narrow scope threaded through the nostril to the top of the throat. This technique can reveal abnormalities in how the vocal folds move, but it doesn’t explain why vocal nodules develop in the first place. Did the unusual vocal cord movement cause the nodules, or did the nodules come first?

“We don’t know why kids get in these patterns,” says Heller Murray. “Even at a young age, they can realize that they’re not able to do everything they want with their voice. They’re not all going to be actors and singers, but you want them to be able to give a book report without getting hoarse.”

In summer 2017, with support from a three-year National Institutes of Health predoctoral research grant, Heller Murray initiated a series of experiments designed to zero in on the cause of vocal nodules and ultimately help prevent them from forming. She thinks the fault might be a break or kink in the neural feedback loop that allows us to adjust the pitch and quality of our voice based on what we hear.

She is testing that idea in participants between the ages of 7 and 11, half of whom have vocal nodules and half of whom don’t. While each participant says a steady “ah” and listens to the sound of his or her voice through headphones, Heller Murray secretly nudges the pitch of the playback about half a note higher or lower. If the brain’s feedback system is working correctly, the participant should adjust his or her pitch to try to return to the target note. If there is a flaw in the brain’s feedback system, though, the child may not adjust their pitch, or may over- or under-correct.

“No one has looked at children with voice disorders in this way.”

—Cara Stepp

The experiment is the first of its kind in children. “It’s very innovative. No one has looked at children with voice disorders in this way,” says Heller Murray’s mentor, Assistant Professor Cara Stepp, who directs the STEPP LAB for Sensorimotor Rehabilitation Engineering at Sargent and has done similar work with adults.

To figure out how to adapt the experiments for kids, Heller Murray drew on years of experience working with young people, including a job as a speech-language pathologist at Boston Children’s Hospital. “Clinically, it’s a population that I love,” says Heller Murray. “It’s always different. You’re always thinking and adapting your skills.”

While the immediate goal is to help kids maintain healthy voices, Heller Murray also hopes her work can serve as a foundation for a new science of vocal development, analogous to the well-studied field of speech development in young children. “The interaction between development and voice is fascinating,” says Heller Murray. “There’s just so much to be learned about this developing vocal system.”

Read more stories from Inside Sargent here.