Melodic Intonation Therapy in Chronic Aphasia: Evidence from a Pilot Randomized Controlled Trial.
Front Hum Neurosci. 2016;10:533
Authors: Van Der Meulen I, Van De Sandt-Koenderman MW, Heijenbrok MH, Visch-Brink E, Ribbers GM
Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed.
CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NTR 1961.
PMID: 27847473 [PubMed - in process]
Improved Neural Processing Efficiency in a Chronic Aphasia Patient Following Melodic Intonation Therapy: A Neuropsychological and Functional MRI Study.
Front Neurol. 2016;7:148
Authors: Tabei KI, Satoh M, Nakano C, Ito A, Shimoji Y, Kida H, Sakuma H, Tomimoto H
Melodic intonation therapy (MIT) is a treatment program for the rehabilitation of aphasic patients with speech production disorders. We report a case of severe chronic non-fluent aphasia unresponsive to several years of conventional therapy that showed a marked improvement following intensive 9-day training on the Japanese version of MIT (MIT-J). The purpose of this study was to verify the efficacy of MIT-J by functional assessment and examine associated changes in neural processing by functional magnetic resonance imaging. MIT improved language output and auditory comprehension, and decreased the response time for picture naming. Following MIT-J, an area of the right hemisphere was less activated on correct naming trials than compared with before training but similarly activated on incorrect trials. These results suggest that the aphasic symptoms of our patient were improved by increased neural processing efficiency and a concomitant decrease in cognitive load.
PMID: 27698650 [PubMed - in process]
Rehabilitation of aphasia: application of melodic-rhythmic therapy to Italian language.
Front Hum Neurosci. 2015;9:520
Authors: Cortese MD, Riganello F, Arcuri F, Pignataro LM, Buglione I
Aphasia is a complex disorder, frequent after stroke (with an incidence of 38%), with a detailed pathophysiological characterization. Effective approaches are crucial for devising an efficient rehabilitative strategy, in order to address the everyday life and professional disability. Several rehabilitative procedures are based on psycholinguistic, cognitive, psychosocial or pragmatic approaches, including amongst those with a neurobehavioral approach the Melodic Intonation Therapy (MIT). Van Eeckhout's adaptation of MIT to French language (Melodic-Rhythmic Therapy: MRT) has implemented the training strategy by adding a rhythmic structure reproducing French prosody. The purpose of this study was to adapt MRT rehabilitation procedures to Italian language and to verify its efficacy in a group of six chronic patients (five males) with severe non-fluent aphasia and without specific aphasic treatments during the previous 9 months. The patients were treated 4 days a week for 16 weeks, with sessions of 30-40 min. They were assessed 6 months after the end of the treatment (follow-up). The patients showed a significant improvement at the Aachener Aphasie Test (AAT) in different fields of spontaneous speech, with superimposable results at the follow-up. Albeit preliminary, these findings support the use of MRT in the rehabilitation after stroke. Specifically, MRT seems to benefit from its stronger structure than the available stimulation-facilitation procedures and allows a better quantification of the rehabilitation efficacy.
PMID: 26441615 [PubMed]
Apollo's gift: new aspects of neurologic music therapy.
Prog Brain Res. 2015;217:237-52
Authors: Altenmüller E, Schlaug G
Music listening and music making activities are powerful tools to engage multisensory and motor networks, induce changes within these networks, and foster links between distant, but functionally related brain regions with continued and life-long musical practice. These multimodal effects of music together with music's ability to tap into the emotion and reward system in the brain can be used to facilitate and enhance therapeutic approaches geared toward rehabilitating and restoring neurological dysfunctions and impairments of an acquired or congenital brain disorder. In this article, we review plastic changes in functional networks and structural components of the brain in response to short- and long-term music listening and music making activities. The specific influence of music on the developing brain is emphasized and possible transfer effects on emotional and cognitive processes are discussed. Furthermore, we present data on the potential of using musical tools and activities to support and facilitate neurorehabilitation. We will focus on interventions such as melodic intonation therapy and music-supported motor rehabilitation to showcase the effects of neurologic music therapies and discuss their underlying neural mechanisms.
PMID: 25725918 [PubMed - indexed for MEDLINE]
Musicians and music making as a model for the study of brain plasticity.
Prog Brain Res. 2015;217:37-55
Authors: Schlaug G
Playing a musical instrument is an intense, multisensory, and motor experience that usually commences at an early age and requires the acquisition and maintenance of a range of sensory and motor skills over the course of a musician's lifetime. Thus, musicians offer an excellent human model for studying behavioral-cognitive as well as brain effects of acquiring, practicing, and maintaining these specialized skills. Research has shown that repeatedly practicing the association of motor actions with specific sound and visual patterns (musical notation), while receiving continuous multisensory feedback will strengthen connections between auditory and motor regions (e.g., arcuate fasciculus) as well as multimodal integration regions. Plasticity in this network may explain some of the sensorimotor and cognitive enhancements that have been associated with music training. Furthermore, the plasticity of this system as a result of long term and intense interventions suggest the potential for music making activities (e.g., forms of singing) as an intervention for neurological and developmental disorders to learn and relearn associations between auditory and motor functions such as vocal motor functions.
PMID: 25725909 [PubMed - indexed for MEDLINE]
Insight into the neurophysiological processes of melodically intoned language with functional MRI.
Brain Behav. 2014 Sep;4(5):615-25
Authors: Méndez Orellana CP, van de Sandt-Koenderman ME, Saliasi E, van der Meulen I, Klip S, van der Lugt A, Smits M
BACKGROUND: Melodic Intonation Therapy (MIT) uses the melodic elements of speech to improve language production in severe nonfluent aphasia. A crucial element of MIT is the melodically intoned auditory input: the patient listens to the therapist singing a target utterance. Such input of melodically intoned language facilitates production, whereas auditory input of spoken language does not.
METHODS: Using a sparse sampling fMRI sequence, we examined the differential auditory processing of spoken and melodically intoned language. Nineteen right-handed healthy volunteers performed an auditory lexical decision task in an event related design consisting of spoken and melodically intoned meaningful and meaningless items. The control conditions consisted of neutral utterances, either melodically intoned or spoken.
RESULTS: Irrespective of whether the items were normally spoken or melodically intoned, meaningful items showed greater activation in the supramarginal gyrus and inferior parietal lobule, predominantly in the left hemisphere. Melodically intoned language activated both temporal lobes rather symmetrically, as well as the right frontal lobe cortices, indicating that these regions are engaged in the acoustic complexity of melodically intoned stimuli. Compared to spoken language, melodically intoned language activated sensory motor regions and articulatory language networks in the left hemisphere, but only when meaningful language was used.
DISCUSSION: Our results suggest that the facilitatory effect of MIT may - in part - depend on an auditory input which combines melody and meaning.
CONCLUSION: Combined melody and meaning provide a sound basis for the further investigation of melodic language processing in aphasic patients, and eventually the neurophysiological processes underlying MIT.
PMID: 25328839 [PubMed - indexed for MEDLINE]
The Combination of Rhythm and Pitch Can Account for the Beneficial Effect of Melodic Intonation Therapy on Connected Speech Improvements in Broca's Aphasia.
Front Hum Neurosci. 2014;8:592
Authors: Zumbansen A, Peretz I, Hébert S
Melodic intonation therapy (MIT) is a structured protocol for language rehabilitation in people with Broca's aphasia. The main particularity of MIT is the use of intoned speech, a technique in which the clinician stylizes the prosody of short sentences using simple pitch and rhythm patterns. In the original MIT protocol, patients must repeat diverse sentences in order to espouse this way of speaking, with the goal of improving their natural, connected speech. MIT has long been regarded as a promising treatment but its mechanisms are still debated. Recent work showed that rhythm plays a key role in variations of MIT, leading to consider the use of pitch as relatively unnecessary in MIT. Our study primarily aimed to assess the relative contribution of rhythm and pitch in MIT's generalization effect to non-trained stimuli and to connected speech. We compared a melodic therapy (with pitch and rhythm) to a rhythmic therapy (with rhythm only) and to a normally spoken therapy (without melodic elements). Three participants with chronic post-stroke Broca's aphasia underwent the treatments in hourly sessions, 3 days per week for 6 weeks, in a cross-over design. The informativeness of connected speech, speech accuracy of trained and non-trained sentences, motor-speech agility, and mood was assessed before and after the treatments. The results show that the three treatments improved speech accuracy in trained sentences, but that the combination of rhythm and pitch elicited the strongest generalization effect both to non-trained stimuli and connected speech. No significant change was measured in motor-speech agility or mood measures with either treatment. The results emphasize the beneficial effect of both rhythm and pitch in the efficacy of original MIT on connected speech, an outcome of primary clinical importance in aphasia therapy.
PMID: 25157222 [PubMed]
Intensive therapy induces contralateral white matter changes in chronic stroke patients with Broca's aphasia.
Brain Lang. 2014 Sep;136:1-7
Authors: Wan CY, Zheng X, Marchina S, Norton A, Schlaug G
Using a pre-post design, eleven chronic stroke patients with large left hemisphere lesions and nonfluent aphasia underwent diffusion tensor imaging and language testing before and after receiving 15 weeks of an intensive intonation-based speech therapy. This treated patient group was compared to an untreated patient group (n=9) scanned twice over a similar time period. Our results showed that the treated group, but not the untreated group, had reductions in fractional anisotropy in the white matter underlying the right inferior frontal gyrus (IFG, pars opercularis and pars triangularis), the right posterior superior temporal gyrus, and the right posterior cingulum. Furthermore, we found that greater improvements in speech production were associated with greater reductions in FA in the right IFG (pars opercularis). Thus, our findings showed that an intensive rehabilitation program for patients with nonfluent aphasia led to structural changes in the right hemisphere, which correlated with improvements in speech production.
PMID: 25041868 [PubMed - indexed for MEDLINE]
Neurobiological, cognitive, and emotional mechanisms in melodic intonation therapy.
Front Hum Neurosci. 2014;8:401
Authors: Merrett DL, Peretz I, Wilson SJ
Singing has been used in language rehabilitation for decades, yet controversy remains over its effectiveness and mechanisms of action. Melodic Intonation Therapy (MIT) is the most well-known singing-based therapy; however, speculation surrounds when and how it might improve outcomes in aphasia and other language disorders. While positive treatment effects have been variously attributed to different MIT components, including melody, rhythm, hand-tapping, and the choral nature of the singing, there is uncertainty about the components that are truly necessary and beneficial. Moreover, the mechanisms by which the components operate are not well understood. Within the literature to date, proposed mechanisms can be broadly grouped into four categories: (1) neuroplastic reorganization of language function, (2) activation of the mirror neuron system and multimodal integration, (3) utilization of shared or specific features of music and language, and (4) motivation and mood. In this paper, we review available evidence for each mechanism and propose that these mechanisms are not mutually exclusive, but rather represent different levels of explanation, reflecting the neurobiological, cognitive, and emotional effects of MIT. Thus, instead of competing, each of these mechanisms may contribute to language rehabilitation, with a better understanding of their relative roles and interactions allowing the design of protocols that maximize the effectiveness of singing therapy for aphasia.
PMID: 24917811 [PubMed]
Augmenting melodic intonation therapy with non-invasive brain stimulation to treat impaired left-hemisphere function: two case studies.
Front Psychol. 2014;5:37
Authors: Al-Janabi S, Nickels LA, Sowman PF, Burianová H, Merrett DL, Thompson WF
The purpose of this study was to investigate whether or not the right hemisphere can be engaged using Melodic Intonation Therapy (MIT) and excitatory repetitive transcranial magnetic stimulation (rTMS) to improve language function in people with aphasia. The two participants in this study (GOE and AMC) have chronic non-fluent aphasia. A functional Magnetic Resonance Imaging (fMRI) task was used to localize the right Broca's homolog area in the inferior frontal gyrus for rTMS coil placement. The treatment protocol included an rTMS phase, which consisted of 3 treatment sessions that used an excitatory stimulation method known as intermittent theta burst stimulation, and a sham-rTMS phase, which consisted of 3 treatment sessions that used a sham coil. Each treatment session was followed by 40 min of MIT. A linguistic battery was administered after each session. Our findings show that one participant, GOE, improved in verbal fluency and the repetition of phrases when treated with MIT in combination with TMS. However, AMC showed no evidence of behavioral benefit from this brief treatment trial. Post-treatment neural activity changes were observed for both participants in the left Broca's area and right Broca's homolog. These case studies indicate that a combination of MIT and rTMS applied to the right Broca's homolog has the potential to improve speech and language outcomes for at least some people with post-stroke aphasia.
PMID: 24550864 [PubMed]
Melodic intonation therapy: back to basics for future research.
Front Neurol. 2014;5:7
Authors: Zumbansen A, Peretz I, Hébert S
We present a critical review of the literature on melodic intonation therapy (MIT), one of the most formalized treatments used by speech-language therapist in Broca's aphasia. We suggest basic clarifications to enhance the scientific support of this promising treatment. First, therapeutic protocols using singing as a speech facilitation technique are not necessarily MIT. The goal of MIT is to restore propositional speech. The rationale is that patients can learn a new way to speak through singing by using language-capable regions of the right cerebral hemisphere. Eventually, patients are supposed to use this way of speaking permanently but not to sing overtly. We argue that many treatment programs covered in systematic reviews on MIT's efficacy do not match MIT's therapeutic goal and rationale. Critically, we identified two main variations of MIT: the French thérapie mélodique et rythmée (TMR) that trains patients to use singing overtly as a facilitation technique in case of speech struggle and palliative versions of MIT that help patients with the most severe expressive deficits produce a limited set of useful, readymade phrases. Second, we distinguish between the immediate effect of singing on speech production and the long-term effect of the entire program on language recovery. Many results in the MIT literature can be explained by this temporal perspective. Finally, we propose that MIT can be viewed as a treatment of apraxia of speech more than aphasia. This issue should be explored in future experimental studies.
PMID: 24478754 [PubMed]
The Efficacy and Timing of Melodic Intonation Therapy in Subacute Aphasia.
Neurorehabil Neural Repair. 2014 Jul;28(6):536-44
Authors: van der Meulen I, van de Sandt-Koenderman WM, Heijenbrok-Kal MH, Visch-Brink EG, Ribbers GM
Background Little is known about the efficacy of language production treatment in subacute severe nonfluent aphasia. Although Melodic Intonation Therapy (MIT) is a language production treatment for this disorder, until now MIT effect studies have focused on chronic aphasia. Purpose This study examines whether language production treatment with MIT is effective in subacute severe nonfluent aphasia. Methods A multicenter, randomized controlled trial was conducted in a waiting-list control design: patients were randomly allocated to the experimental group (MIT) or the control group (control intervention followed by delayed MIT). In both groups, therapy started at 2 to 3 months poststroke and was given intensively (5 h/wk) during 6 weeks. In a second therapy period, the control group received 6 weeks of intensive MIT. The experimental group resumed their regular treatment. Assessment was done at baseline (T1), after the first intervention period (T2), and after the second intervention period (T3). Efficacy was evaluated at T2. The impact of delaying MIT on therapy outcome was also examined. Results A total of 27 participants were included: n = 16 in the experimental group and n = 11 in the control group. A significant effect in favor of MIT on language repetition was observed for trained items, with mixed results for untrained items. After MIT there was a significant improvement in verbal communication but not after the control intervention. Finally, delaying MIT was related to less improvement in the repetition of trained material. Conclusions In these patients with subacute severe nonfluent aphasia, language production treatment with MIT was effective. Earlier treatment may lead to greater improvement.
PMID: 24449708 [PubMed]
The therapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients.
Ann Rehabil Med. 2013 Aug;37(4):556-62
Authors: Lim KB, Kim YK, Lee HJ, Yoo J, Hwang JY, Kim JA, Kim SK
OBJECTIVE: To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients.
METHODS: Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy.
RESULTS: Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients.
CONCLUSION: We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.
PMID: 24020037 [PubMed]
How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery.
Front Hum Neurosci. 2013;7:35
Authors: Stahl B, Henseler I, Turner R, Geyer S, Kotz SA
There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases-known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources-even without singing.
PMID: 23450277 [PubMed]
When right is all that is left: plasticity of right-hemisphere tracts in a young aphasic patient.
Ann N Y Acad Sci. 2012 Apr;1252:237-45
Authors: Zipse L, Norton A, Marchina S, Schlaug G
Using an adapted version of Melodic Intonation Therapy (MIT), we treated an adolescent girl with a very large left-hemisphere lesion and severe nonfluent aphasia secondary to an ischemic stroke. At the time of her initial assessment 15 months after her stroke, she had reached a plateau in her recovery despite intense and long-term traditional speech-language therapy (approximately five times per week for more than one year). Following an intensive course of treatment with our adapted form of MIT, her performance improved on both trained and untrained phrases, as well as on speech and language tasks. These behavioral improvements were accompanied by functional MRI changes in the right frontal lobe as well as by an increased volume of white matter pathways in the right hemisphere. No increase in white matter volume was seen in her healthy twin sister, who was scanned twice over the same time period. This case study not only provides further evidence for MIT's effectiveness, but also indicates that intensive treatment can induce functional and structural changes in a right-hemisphere fronto-temporal network.
PMID: 22524365 [PubMed - indexed for MEDLINE]
The effects of modified melodic intonation therapy on nonfluent aphasia: a pilot study.
J Speech Lang Hear Res. 2012 Oct;55(5):1463-71
Authors: Conklyn D, Novak E, Boissy A, Bethoux F, Chemali K
OBJECTIVE: Positive results have been reported with melodic intonation therapy (MIT) in nonfluent aphasia patients with damage to their left-brain speech processes, using the patient's intact ability to sing to promote functional language. This pilot study sought to determine the immediate effects of introducing modified melodic intonation therapy (MMIT), a modification of MIT, as an early intervention in stroke patients presenting with Broca's aphasia.
METHOD: After a randomized controlled single-blind design, 30 acute stroke survivors with nonfluent aphasia were randomly assigned to receive MIT treatment or no treatment. A pre/post test, based on the responsive and repetition subsections of the Western Aphasia Battery, was developed for this study.
RESULTS: After 1 session, a significant within-subject change was observed for the treatment group's adjusted total score ( p = .02), and a significant difference between groups was found for adjusted total score ( p = .02) favoring the treatment group. The treatment group also showed a significant change in their responsive subsection scores ( p = .01) when their pre-tests from Visit 1 to Visit 2 were compared, whereas the control group showed no change, suggesting a possible carry-over effect of MIT treatment.
CONCLUSION: This study provides preliminary data supporting the possible benefits of utilizing MMIT treatment early in the recovery of nonfluent aphasia patients.
PMID: 22411278 [PubMed - indexed for MEDLINE]
Melodic Intonation Therapy: present controversies and future opportunities.
Arch Phys Med Rehabil. 2012 Jan;93(1 Suppl):S46-52
Authors: van der Meulen I, van de Sandt-Koenderman ME, Ribbers GM
This article describes the state of the art of Melodic Intonation Therapy (MIT), a structured aphasia therapy program using the melodic aspects of language (intonation, rhythm, and stress) to improve language production. MIT was developed in the 1970s and is still used worldwide. Nevertheless, we argue that many questions crucial for the clinical application of MIT are still unanswered. First, a review of MIT effect studies is presented showing that evidence from well-designed group studies is still lacking. It is also unclear which aspects of MIT contribute most to its therapeutic effect and which underlying neural mechanisms are involved. Two cases are presented illustrating unsolved questions concerning MIT in clinical practice, such as candidacy and the best timing of this therapy.
PMID: 22202191 [PubMed - indexed for MEDLINE]
[Music therapy for dementia and higher cognitive dysfunction: a review].
Brain Nerve. 2011 Dec;63(12):1370-7
Authors: Satoh M
Music is known to affect the human mind and body. Music therapy utilizes the effects of music for medical purposes. The history of music therapy is quite long, but only limited evidence supports its usefulness in the treatment of higher cognitive dysfunction. As for dementia, some studies conclude that music therapy is effective for preventing cognitive deterioration and the occurrence of behavioral and psychological symptoms of dementia (BPSD). In patients receiving music therapy for the treatment of higher cognitive dysfunction, aphasia was reported as the most common symptom. Many studies have been conducted to determine whether singing can improve aphasic symptoms: singing familiar and/or unfamiliar songs did not show any positive effect on aphasia. Melodic intonation therapy (MIT) is a method that utilizes melody and rhythm to improve speech output. MIT is a method that is known to have positive effects on aphasic patients. Some studies of music therapy for patients with unilateral spatial neglect; apraxia; hemiparesis; and walking disturbances, including parkinsonian gait, are available in the literature. Studies showed that the symptoms of unilateral spatial neglect and hemiparesis significantly improved when musical instruments were played for several months as a part of the music therapy. Here, I describe my study in which mental singing showed a positive effect on parkinsonian gait. Music is interesting, and every patient can go through training without any pain. Future studies need to be conducted to establish evidence of the positive effects of music therapy on neurological and neuropsychological symptoms.
PMID: 22147456 [PubMed - indexed for MEDLINE]
Non-invasive brain stimulation enhances the effects of melodic intonation therapy.
Front Psychol. 2011;2:230
Authors: Vines BW, Norton AC, Schlaug G
Research has suggested that a fronto-temporal network in the right hemisphere may be responsible for mediating melodic intonation therapy's (MIT) positive effects on speech recovery. We investigated the potential for a non-invasive brain stimulation technique, transcranial direct current stimulation (tDCS), to augment the benefits of MIT in patients with non-fluent aphasia by modulating neural activity in the brain during treatment with MIT. The polarity of the current applied to the scalp determines the effects of tDCS on the underlying tissue: anodal-tDCS increases excitability, whereas cathodal tDCS decreases excitability. We applied anodal-tDCS to the posterior inferior frontal gyrus of the right hemisphere, an area that has been shown both to contribute to singing through the mapping of sounds to articulatory actions and to serve as a key region in the process of recovery from aphasia, particularly in patients with large left hemisphere lesions. The stimulation was applied while patients were treated with MIT by a trained therapist. Six patients with moderate to severe non-fluent aphasia underwent three consecutive days of anodal-tDCS + MIT, and an equivalent series of sham-tDCS + MIT. The two treatment series were separated by 1 week, and the order in which the treatments were administered was randomized. Compared to the effects of sham-tDCS + MIT, anodal-tDCS + MIT led to significant improvements in fluency of speech. These results support the hypothesis that, as the brain seeks to reorganize and compensate for damage to left hemisphere language centers, combining anodal-tDCS with MIT may further recovery from post-stroke aphasia by enhancing activity in a right hemisphere sensorimotor network for articulation.
PMID: 21980313 [PubMed]
From singing to speaking: facilitating recovery from nonfluent aphasia.
Future Neurol. 2010 Sep;5(5):657-665
Authors: Schlaug G, Norton A, Marchina S, Zipse L, Wan CY
It has been reported for more than 100 years that patients with severe nonfluent aphasia are better at singing lyrics than they are at speaking the same words. This observation led to the development of melodic intonation therapy (MIT). However, the efficacy of this therapy has yet to be substantiated in a randomized controlled trial. Furthermore, its underlying neural mechanisms remain unclear. The two unique components of MIT are the intonation of words and simple phrases using a melodic contour that follows the prosody of speech and the rhythmic tapping of the left hand that accompanies the production of each syllable and serves as a catalyst for fluency. Research has shown that both components are capable of engaging fronto-temporal regions in the right hemisphere, thereby making MIT particularly well suited for patients with large left hemisphere lesions who also suffer from nonfluent aphasia. Recovery from aphasia can happen in two ways: either through the recruitment of perilesional brain regions in the affected hemisphere, with variable recruitment of right-hemispheric regions if the lesion is small, or through the recruitment of homologous language and speech-motor regions in the unaffected hemisphere if the lesion of the affected hemisphere is extensive. Treatment-associated neural changes in patients undergoing MIT indicate that the unique engagement of right-hemispheric structures (e.g., the superior temporal lobe, primary sensorimotor, premotor and inferior frontal gyrus regions) and changes in the connections across these brain regions may be responsible for its therapeutic effect.
PMID: 21088709 [PubMed - as supplied by publisher]
Current trends in stroke rehabilitation. A review with focus on brain plasticity.
Acta Neurol Scand. 2011 Mar;123(3):147-59
Authors: Johansson BB
Current understanding of brain plasticity has lead to new approaches in ischemic stroke rehabilitation. Stroke units that combine good medical and nursing care with task-oriented intense training in an environment that provides confidence, stimulation and motivation significantly improve outcome. Repetitive trans-cranial magnetic stimulation (rTMS), and trans-cranial direct current stimulation (tDCS) are applied in rehabilitation of motor function. The long-term effect, optimal way of stimulation and possibly efficacy in cognitive rehabilitation need evaluation. Methods based on multisensory integration of motor, cognitive, and perceptual processes including action observation, mental training, and virtual reality are being tested. Different approaches of intensive aphasia training are described. Recent data on intensive melodic intonation therapy indicate that even patients with very severe non-fluent aphasia can regain speech through homotopic white matter tract plasticity. Music therapy is applied in motor and cognitive rehabilitation. To avoid the confounding effect of spontaneous improvement, most trials are preformed ≥3 months post stroke. Randomized controlled trials starting earlier after strokes are needed. More attention should be given to stroke heterogeneity, cognitive rehabilitation, and social adjustment and to genetic differences, including the role of BDNF polymorphism in brain plasticity.
PMID: 20726844 [PubMed - indexed for MEDLINE]
Processing melodic contour and speech intonation in congenital amusics with Mandarin Chinese.
Neuropsychologia. 2010 Jul;48(9):2630-9
Authors: Jiang C, Hamm JP, Lim VK, Kirk IJ, Yang Y
Congenital amusia is a disorder in the perception and production of musical pitch. It has been suggested that early exposure to a tonal language may compensate for the pitch disorder (Peretz, 2008). If so, it is reasonable to expect that there would be different characterizations of pitch perception in music and speech in congenital amusics who speak a tonal language, such as Mandarin. In this study, a group of 11 adults with amusia whose first language was Mandarin were tested with melodic contour and speech intonation discrimination and identification tasks. The participants with amusia were impaired in discriminating and identifying melodic contour. These abnormalities were also detected in identifying both speech and non-linguistic analogue derived patterns for the Mandarin intonation tasks. In addition, there was an overall trend for the participants with amusia to show deficits with respect to controls in the intonation discrimination tasks for both speech and non-linguistic analogues. These findings suggest that the amusics' melodic pitch deficits may extend to the perception of speech, and could potentially result in some language deficits in those who speak a tonal language.
PMID: 20471406 [PubMed - indexed for MEDLINE]
Melodic intonation therapy: shared insights on how it is done and why it might help.
Ann N Y Acad Sci. 2009 Jul;1169:431-6
Authors: Norton A, Zipse L, Marchina S, Schlaug G
For more than 100 years, clinicians have noted that patients with nonfluent aphasia are capable of singing words that they cannot speak. Thus, the use of melody and rhythm has long been recommended for improving aphasic patients' fluency, but it was not until 1973 that a music-based treatment [Melodic Intonation Therapy (MIT)] was developed. Our ongoing investigation of MIT's efficacy has provided valuable insight into this therapy's effect on language recovery. Here we share those observations, our additions to the protocol that aim to enhance MIT's benefit, and the rationale that supports them.
PMID: 19673819 [PubMed - indexed for MEDLINE]
Evidence for plasticity in white-matter tracts of patients with chronic Broca's aphasia undergoing intense intonation-based speech therapy.
Ann N Y Acad Sci. 2009 Jul;1169:385-94
Authors: Schlaug G, Marchina S, Norton A
Recovery from aphasia can be achieved through recruitment of either perilesional brain regions in the affected hemisphere or homologous language regions in the nonlesional hemisphere. For patients with large left-hemisphere lesions, recovery through the right hemisphere may be the only possible path. The right-hemisphere regions most likely to play a role in this recovery process are the superior temporal lobe (important for auditory feedback control), premotor regions/posterior inferior frontal gyrus (important for planning and sequencing of motor actions and for auditory-motor mapping), and the primary motor cortex (important for execution of vocal motor actions). These regions are connected reciprocally via a major fiber tract called the arcuate fasciculus (AF), however, this tract is not as well developed in the right hemisphere as it is in the dominant left. We tested whether an intonation-based speech therapy (i.e., melodic intonation therapy [MIT]), which is typically administered in an intense fashion with 75-80 daily therapy sessions, would lead to changes in white-matter tracts, particularly the AF. Using diffusion tensor imaging (DTI), we found a significant increase in the number of AF fibers and AF volume comparing post- with pretreatment assessments in six patients that could not be attributed to scan-to-scan variability. This suggests that intense, long-term MIT leads to remodeling of the right AF and may provide an explanation for the sustained therapy effects that were seen in these six patients.
PMID: 19673813 [PubMed - indexed for MEDLINE]
Changes in maps of language activity activation following melodic intonation therapy using magnetoencephalography: two case studies.
J Clin Exp Neuropsychol. 2010 Mar;32(3):309-14
Authors: Breier JI, Randle S, Maher LM, Papanicolaou AC
Two patients with chronic expressive aphasia underwent two blocks of melodic intonation therapy (MIT) each. Maps of language-specific neurophysiological activity were obtained prior to and after each MIT block during a covert action naming task using magnetoencephalography. Both patients exhibited increased left hemisphere activation after MIT. The patient who responded positively to therapy exhibited decreasing activation within areas of the right hemisphere homotopic to left hemisphere language areas compared to baseline after both blocks of MIT. In contrast, the patient who did not show improvement after therapy exhibited increasing activation in these areas of the right hemisphere after therapy. Results are consistent with hypotheses that melodic intonation therapy acts through promotion of left hemisphere activation.
PMID: 19657914 [PubMed - indexed for MEDLINE]
A pilot study into the effect of vocal exercises and singing on dysarthric speech.
Authors: Tamplin J
This pilot study aimed to investigate the effects of vocal exercises and singing on intelligibility and speech naturalness for subjects with acquired dysarthria following traumatic brain injury or stroke. A multiple case study design was used, involving pre, mid, and post-treatment assessments of intelligibility, rate, naturalness, and pause time for four subjects with dysarthria. Each subject participated in 24 individual music therapy sessions over eight weeks involving oral motor respiratory exercises, rhythmic and melodic articulation exercises, rhythmic speech cuing, vocal intonation therapy, and therapeutic singing using familiar songs. Results were measured using a standardized dysarthric speech assessment--the Sentence Intelligibility Test, waveform analysis, and ratings of speech naturalness. Statistically significant improvements in functional speech intelligibility were achieved but improvements in rate of speech were not significant. Speech naturalness improved post-treatment and a reduction in the number and length of pauses was verified via waveform analysis. Preliminary findings suggest that a program of vocal exercises and singing may facilitate more normative speech production for people with acquired dysarthria and support the need for further research in this area.
PMID: 18560137 [PubMed - indexed for MEDLINE]
From Singing to Speaking: Why Singing May Lead to Recovery of Expressive Language Function in Patients with Broca's Aphasia.
Music Percept. 2008 Apr 01;25(4):315-323
Authors: Schlaug G, Marchina S, Norton A
It has been reported that patients with severely nonfluent aphasia are better at singing lyrics than speaking the same words. This observation inspired the development of Melodic Intonation Therapy (MIT), a treatment whose effects have been shown, but whose efficacy is unproven and neural correlates remain unidentified. Because of its potential to engage/unmask language-capable regions in the unaffected right hemisphere, MIT is particularly well suited for patients with large left-hemisphere lesions. Using two patients with similar impairments and stroke size/location, we show the effects of MIT and a control intervention. Both interventions' post-treatment outcomes revealed significant improvement in propositional speech that generalized to unpracticed words and phrases; however, the MIT-treated patient's gains surpassed those of the control-treated patient. Treatment-associated imaging changes indicate that MIT's unique engagement of the right hemisphere, both through singing and tapping with the left hand to prime the sensorimotor and premotor cortices for articulation, accounts for its effect over nonintoned speech therapy.
PMID: 21197418 [PubMed - as supplied by publisher]
[Music therapy and neuropsychology: a proposal to music therapy based on the cognitive processing of music].
Rinsho Shinkeigaku. 2007 Nov;47(11):868-70
Authors: Satoh M, Takeda K, Kuzuhara S
In the last decade, a considerable number of studies have been made on the cognitive processing of music. A patient with pure amusia due to the infarction of anterior portion of bilateral temporal lobes revealed the disturbance of the discrimination of chords. Using positron emission tomography, these regions were activated when musically naive normal subjects listened to the harmony compared to the rhythm of identical music. So, we concluded that anterior temporal portion might participate in the recognition of chords. Several articles reported that the musician's brain was different from nonmusicians' functionally and anatomically. This difference was considered to be caused by the musical training for a long time. Recent studies clarified that the reorganization might occur by musical training for a few months. Melodic intonation therapy (MIT) is a method aimed to improve speech output of aphasic patients, using short melodic phrase with a word. The literatures of mental processing of music suggested that right hemisphere might participate in the expression of music, namely singing and playing instrumentals. So, it was supposed that MIT utilized the compensational function of right hemisphere for damaged left hemisphere. We also reported that mental singing improved the gait disturbance of patients with Parkinson's disease. Music therapy is changing from a social science model based on the individual experiences to a neuroscience-guided model based on brain function and cognitive processing of the perception and expression of music.
PMID: 18210821 [PubMed - indexed for MEDLINE]
[Can music therapy for patients with neurological disorders?].
Tidsskr Nor Laegeforen. 2004 Dec 16;124(24):3229-30
Authors: Myskja A
Recent developments in brain research and in the field of music therapy have led to the development of music-based methods specifically aimed at relieving symptoms of Parkinson's disease and other neurologic disorders. Rhythmic auditory stimulation uses external rhythmic auditory cues from song, music or metronome to aid patients improving their walking functioning and has been shown to be effective both within sessions and as a result of training over time. Melodic intonation therapy and related vocal techniques can improve expressive dysphasia and aid rehabilitation of neurologic disorders, particularly Parkinson's disease, stroke and developmental disorders.
PMID: 15608775 [PubMed - indexed for MEDLINE]
Processing prosodic and musical patterns: a neuropsychological investigation.
Brain Lang. 1998 Jan;61(1):123-44
Authors: Patel AD, Peretz I, Tramo M, Labreque R
To explore the relationship between the processing of melodic and rhythmic patterns in speech and music, we tested the prosodic and musical discrimination abilities of two "amusic" subjects who suffered from music perception deficits secondary to bilateral brain damage. Prosodic discrimination was assessed with sentence pairs where members of a pair differed by intonation or rhythm, and musical discrimination was tested using musical-phrase pairs derived from the prosody of the sentence pairs. This novel technique was chosen to make task demands as comparable as possible across domains. One amusic subject showed good performance on both linguistic and musical discrimination tasks, while the other had difficulty with both tasks. In both subjects, level of performance was statistically similar across domains, suggesting shared neural resource for prosody and music. Further tests suggested that prosody and music may overlap in the processes used to maintain auditory patterns in working memory.
PMID: 9448936 [PubMed - indexed for MEDLINE]
Labeling of musical interval size by cochlear implant patients and normally hearing subjects.
Ear Hear. 1997 Oct;18(5):364-72
Authors: Pijl S
OBJECTIVE: To compare the performance of cochlear implant patients and normal-hearing subjects on a musical interval labeling task, and to determine whether information regarding musical interval size is available to cochlear implant patients under realistic everyday listening conditions.
DESIGN: Two Nucleus cochlear implant patients listened to musical intervals that consisted of systematic variations of electric pulse rate on single bipolar intracochlear electrode pairs, whereas normal-hearing listeners were presented with the acoustical analog of these stimuli. Subjects labeled the intonation quality of the stimulus intervals ("flat," "sharp," or "in tune"), relative to their memory for specific intervals abstracted from familiar melodies. The cochlear implant patients, in addition, performed this task with realistic acoustical musical stimuli.
RESULTS: The interval labeling behavior of cochlear implant subjects, at low pulse rates, was similar to that of normal-hearing subjects. Furthermore, pitch interval information does not appear to be available to cochlear implant subjects when they are listening to acoustical stimuli via their speech processors.
CONCLUSIONS: Temporal information appears to be sufficient for the perception of musical pitch. Encoding strategies that are highly successful in restoring speech understanding do not necessarily provide information regarding melodic pitch interval size.
PMID: 9360860 [PubMed - indexed for MEDLINE]
Absolute pitch and sex effect event-related potential activity for a melodic interval discrimination task.
J Acoust Soc Am. 1997 Jul;102(1):451-60
Authors: Hantz EC, Kreilick KG, Marvin EW, Chapman RM
Absolute pitch is a special ability which allows for special perceptual/cognitive strategies. Studies have shown differences in event-related scalp potentials between absolute-pitch (AP) and relative-pitch (RP) subjects of equal musical training. In this study, highly trained musicians (15 females/15 males) performed a melodic interval discrimination task, using intervals on-pitch in equal-tempered tuning (A4 = 440 Hz) and tuned a half-semitone sharp. Subjects identified target intervals (probability 0.2) in a series of 400 randomly transposed intervals. AP subjects were expected to perform differently across intonation conditions, whereas RP subjects were not. Event-related potentials (ERPs) were recorded from three midline sites and two lateral sites. ERPs were analyzed by principal component analysis of variance. Sex was also considered as an independent subject variable. Performance was not significantly different either by absolute pitch or sex. Reaction times did not reveal any significant interactions involving AP or sex, but showed a significant effect by response type (target/nontarget). Strong P3 activity appeared to the target melodic intervals regardless of subject group or intonation. PCA factors with maxima at 352, 511, and 709 ms were sensitive to task relevance. Males showed greater positivity than females along the midline. A significant intonation by response type by sex interaction indicated a greater spread of values for females than males, and greater similarity in response by sex for the sharp than the on-pitch intervals. AP subjects showed reduced P3 activity along the midline, but increased over lateral sites. In a difficult musical task, the ERPs were sensitive to the sex of the listeners, as well as to whether they had absolute pitch.
PMID: 9228807 [PubMed - indexed for MEDLINE]
Recovery from nonfluent aphasia after melodic intonation therapy: a PET study.
Neurology. 1996 Dec;47(6):1504-11
Authors: Belin P, Van Eeckhout P, Zilbovicius M, Remy P, François C, Guillaume S, Chain F, Rancurel G, Samson Y
We examined mechanisms of recovery from aphasia in seven nonfluent aphasic patients, who were successfully treated with melodic intonation therapy (MIT) after a lengthy absence of spontaneous recovery. We measured changes in relative cerebral blood flow (CBF) with positron emission tomography (PET) during hearing and repetition of simple words, and during repetition of MIT-loaded words. Without MIT, language tasks abnormally activated right hemisphere regions, homotopic to those activated in the normal subject, and deactivated left hemisphere language zones. In contrast, repeating words with MIT reactivated Broca's area and the left prefrontal cortex, while deactivating the counterpart of Wernicke's area in the right hemisphere. The recovery process induced by MIT in these patients probably coincides with this reactivation of left prefrontal structures. In contrast, the right hemisphere regions abnormally activated during simple language tasks seem to be associated with the initial persistence of the aphasia. This study supports the idea that abnormal activation patterns in the lesioned brain are not necessarily related to the recovery process.
PMID: 8960735 [PubMed - indexed for MEDLINE]
Intonation of musical intervals by musical intervals by deaf subjects stimulated with single bipolar cochlear implant electrodes.
Hear Res. 1995 Sep;89(1-2):203-11
Authors: Pijl S, Schwarz DW
Some subjects with cochlear implants have been shown to associate electrical stimulus pulse rates with the pitches of musical tones. In order to clarify the role of these pitch sensations in a musical context, the present investigation examined the intonation accuracy achieved by implant subjects when adjusting pulse rates in the reconstruction of musical intervals. Using a method of adjustment, the subjects altered a variable pulse rate, relative to a fixed reference rate, on one electrode, in the tuning of musical intervals abstracted from familiar melodies. At low pulse rates, subjects generally tuned the intervals to the same frequency ratios which define tonal musical intervals in normal-hearing listeners, with error margins comparable to musically untrained subjects. Two subjects were, in addition, able to transpose these melodic intervals from a standard reference pulse rate to higher and lower reference rates (reference and target pulse rates with geometric means of the intervals ranging from 81 to 466 pulses/s). Generally, the intervals were adjusted on a ratio scale, according to the same frequency ratios which define analogous acoustical musical intervals. These results support the hypothesis that, at low pulse rates, a temporal code in the auditory nerve alone is capable of defining musical pitch.
PMID: 8600127 [PubMed - indexed for MEDLINE]
Melodic intonation therapy in the verbal decoding of aphasics.
Rom J Neurol Psychiatry. 1995 Jan-Mar;33(1):57-97
Authors: Popovici M
Melodic Intonation Therapy is a well-known method exploring the verbal encoding of aphasics but within this study, it was used to investigate the verbal decoding (the auditory comprehension). Two separate groups, 240 cases each, were investigated, the former with MIT and the latter with other therapy methods. Each group included three subgroups according to the three frequent types of aphasia (Wernicke, Broca and Anomia). The method of semantic fields was associated to treat the second group since it is usually used in the treatment of aphasics with auditory decoding disturbances. All patients were tested twice, before and after therapy.
PMID: 7547372 [PubMed - indexed for MEDLINE]
A clinical perspective: melodic intonation therapy for developmental apraxia.
Clin Commun Disord. 1994 Sep;4(3):175-82
Authors: Helfrich-Miller KR
The therapeutic process is a mix of technique and insight, and effective clinicians are able to blend theory with practice. This is especially true in the area of DAS. Children with the symptom complex of apraxia are a challenge to any therapy program. Clinicians should choose combinations of therapy protocols that best serve the child. MIT is one technique that has been shown to be successful.
PMID: 7994292 [PubMed - indexed for MEDLINE]
Assessment: melodic intonation therapy. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
Neurology. 1994 Mar;44(3 Pt 1):566-8
PMID: 8145935 [PubMed - indexed for MEDLINE]
Melodic intonation in the rehabilitation of Romanian aphasics with bucco-lingual apraxia.
Rom J Neurol Psychiatry. 1992 Apr-Jun;30(2):99-113
Authors: Popovici M, Mihăilescu L
The main objective of the present study was to assess the efficiency of the melodic intonation therapy (MIT) in the rehabilitation of Romanian aphasics. Eighty predominantly Broca aphasics used the melodic intonation therapy when no other therapy methods were very efficient. The speech therapist intonated the respective word, then together with the patient and finally let him continue alone. The control group counted 80 aphasics and it applied other therapy methods. Each patient, regardless of the group, was tested twice, before and after therapy. Since most of the patients displayed severe language disorders, and other therapy methods failed in rehabilitating them, MIT was considered an efficient method in the early stages of Broca aphasia with bucco-lingual apraxia.
PMID: 1520605 [PubMed - indexed for MEDLINE]
[Current status of aphasia therapy].
Fortschr Neurol Psychiatr. 1986 Apr;54(4):119-37
Authors: Lang C, von Stockert TR
Aphasia therapy in adults has been established to a larger extent relatively lately in the history of aphasiology, i.e. after its social medical importance had been realized and one of the cardinal problems of neurology solved more satisfactorily--lesion localization by imaging techniques. In order to evaluate the efficiency of aphasia therapy--which is still not quite uncontradicted--it was necessary to acquire sufficient knowledge of the spontaneous recovery process. It takes place--e.g. after stroke--mainly during the first 3 months, coming, as a rule, to a halt during the first year. Longer recovery periods, however, have been described. Next to etiology neurological status, overall health condition, type and severity of aphasia, and time delay between onset of the disease and start of therapy have been ascertained, whereas age and handedness seem to be of minor relevance. If syndrome change occurs the boundary between Broca's and Wernicke's aphasia is not surpassed; this taken apart almost any change from a more severe to a milder form of aphasia is possible. To isolate the therapeutic effect from spontaneous recovery in larger groups is difficult. There are, however, more recent investigations which suggest, that a correctly indicated therapy, which is sufficiently intensive and lasts long enough, will be effective. One of the corner-stones of any therapeutic effort ist adequate stimulation, oriented toward the patients needs and his aphasic syndrome, and taking into account the systemic nature of language and its most important linguistic structural components. Furthermore, a phase-specific and interdisciplinary approach and integration of closely related persons play an important role. We divide the numerous therapeutic techniques into 3 groups: direct or stimulation approach, indirect or circumventory approach, compensatory or alternative strategies approach. Representatives of all 3 groups are presented briefly, e.g. auditory stimulation, divergent semantic intervention, promoting aphasics communicative effectiveness, language enrichment therapy, programmed instruction; then the deblocking method, melodic intonation therapy, imagery, a sample of linguistically oriented methods for the reeducation of syntax, semantics, and phonemics along with special methods for the treatment of alexia and agraphia; finally compensatory techniques like visual communication, visual action therapy, and bliss symbolics. Some particular problems encountered in working with aphasics are addressed. A point is made about the feasibility and profit of lay therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
PMID: 2423425 [PubMed - indexed for MEDLINE]
CT scan lesion localization and response to melodic intonation therapy with nonfluent aphasia cases.
Cortex. 1985 Jun;21(2):203-23
Authors: Naeser MA, Helm-Estabrooks N
The purpose of this retrospective study was to investigate the relationship between CT scan lesion localization and good or poor response to Melodic Intonation Therapy (MIT) as measured by pre- and post-MIT treatment scores. The four good response (GR) cases improved in speech characteristics ratings for Phrase Length and Grammatical Form on the Boston Diagnostic Aphasia Examination; the four poor response (PR) cases showed no improvement. The GR cases had lesions which involved Broca's area and/or white matter deep to it plus large superior lesion extension into periventricular white matter deep to the lower motor cortex area for face. These GR cases had no large lesion in Wernicke's area and no lesion in the temporal isthmus or the right hemisphere. The PR cases, however, had bi-lateral lesions or lesion including Wernicke's area or the temporal isthmus.
PMID: 4028738 [PubMed - indexed for MEDLINE]
[Japanese-applied melodic intonation therapy for Broca aphasia].
No To Shinkei. 1983 Oct;35(10):1031-7
Authors: Seki K, Sugishita M
Since Albert et al. (1973) published Melodic Intonation Therapy (MIT), this new technique for Broca type aphasics has won a good reputation because of its remarkable efficiency. Many improved cases have been reported. On the contrary, there seems to be no study on MIT in Japan. This gap may be mainly caused by the great difference between two languages which makes difficult to apply original MIT to Japanese language. Through a comparative study of two languages, we have made some amendments on original MIT, which just fit for Japanese. MIT is designed to generate verbal output by embedding target phrases and sentences in a simple, nonliguistically loaded melody pattern. The pattern is consisted of the melody line, the rhythm, and points of stress. Now let us explain our Japanese version of MIT concerning these three elements. As for melody line, our version has only two pitches; high and low, since Japanese language has a pitch accent which is decided in each word. As a result, the melody line of Japanese version is far more simple than the original one, which has four pitches. The rhythm of English is called "stress-timed rhythm", which means that a part between two syllables that have primary stresses tends to be spoken at regular intervals regardless of the number of syllables between them. Consequently, the tempo of speech varies depending on the number of syllables between them. On the other hand, Japanese has "syllable-timed rhythm", which means isosyllabic.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 6651979 [PubMed - indexed for MEDLINE]
Effects of three syllable durations using the melodic intonation therapy technique.
J Speech Hear Res. 1979 Jun;22(2):311-20
Authors: Laughlin SA, Naeser MA, Gordon WP
Five nonfluent aphasics were presented English phrases with three syllable durations; a regular speech, non-intoned duration less than 1 sec per syllable, and two modified Melodic Intonation Therapy (MIT) intoned durations of 1.5 sec per syllable and 2.0 sec per syllable. All subjects had the greatest number of correct phrase productions at the longest MIT duration (p less than 0.001) and the greatest number of failures at the regular non-intoned duration. Therefore, syllable duration is an important acoustic parameter to consider when using an MIT technique with severe nonfluent aphasics.
PMID: 491558 [PubMed - indexed for MEDLINE]
Adapted melodic intonation therapy: a case study of an experimental language program for an autistic child.
J Clin Psychiatry. 1979 Apr;40(4):201-3
Authors: Miller SB, Toca JM
In order to develop a useful communication system, a 3-year-old, non-verbal autistic boy was treated for 1 year with a Simultaneous Communication method involving signed and verbal language. As this procedure proved not useful in this case, an adaptation of Melodic Intonation Therapy (signing plus an intoned rather than spoken verbal stimulus) was tried. With this experimental language treatment, the patient produced trained, imitative and, finally, spontaneous intoned verbalizations which generalized to a variety of situations.
PMID: 422532 [PubMed - indexed for MEDLINE]
Espousing melodic intonation therapy in aphasia rehabilitation: a case study.
Int J Rehabil Res. 1979;2(3):333-42
Authors: Goldfarb R, Bader E
A program of Melodic Intonation Therapy (MIT) was adapted as a home training procedure to enable a severely affected aphasic adult to respond to 52 simple questions bearing relevance to his daily life. MIT involves embedding short phrases or sentences in a simple, non-distinct melody pattern. As the patient progresses through the program, the melodic aspect is faded and the program eventually leads to production of the target phrase or sentence in normal speech prosody. The present procedure consisted of three levels of training designed to advance the subject from an initial level of intoning responses in a simple melody to producing the responses in normal speech prosody. The subject's wife was trained to administer MIT both in the clinical and home settings. Considerable improvement was obtained in imitation and in context related responses to questions. These findings lend support to the proposal that the music dominance to the right hemisphere assists, and perhaps diminishes the language dominance of, the damaged left hemisphere. The limitations of use of Melodic Intonation Therapy were discussed.
PMID: 541150 [PubMed - indexed for MEDLINE]
On: melodic intonation therapy for aphasia by R. W. Sparks and A. L. Holland.
J Speech Hear Disord. 1976 Aug;41(3):298-300
Authors: Berlin CI
PMID: 950788 [PubMed - indexed for MEDLINE]
Method: melodic intonation therapy for aphasia.
J Speech Hear Disord. 1976 Aug;41(3):287-97
Authors: Sparks RW, Holland AL
Melodic intonation therapy (MIT), a method developed to assist the adult aphasic regain verbal communication, is presented with step-by-step procedures and suggestions. Also described is the type of patient for whom the technique appears most successful.
PMID: 950787 [PubMed - indexed for MEDLINE]