Melodic intonation therapy

Definition

Melodic intonation therapy (MIT) uses melodic and rhythmic components to assist in speech recovery for patients with aphasia .

Purpose

Although MIT was first described in the 1970s, it is considered a relatively new and experimental therapy. Few research studies have been performed to analyze the effectiveness of treatment with large numbers of patients. Despite this, some speech therapists use the method for children and adults with aphasia as well as for children with developmental apraxia of speech.

The effectiveness of MIT derives from its use of the musical components melody and rhythm in the production of speech. A group of researchers from the University of Texas have discovered that music stimulates several different areas in the brain, rather than just one isolated area. They also found a strong correlation between the right side of the brain that comprehends music components and the left side of the brain that comprehends language components. Because music and language structures are similar, it is suspected that by stimulating the right side of the brain, the left side will begin to make connections as well. For this reason, patients are encouraged to sing words rather than speak them in conversational tones in the early phases of MIT. Studies using positron emission tomography (PET ) scans have shown Broca's area (a region in the left frontal brain controlling speech and language comprehension) to be reactivated through repetition of sung words.

Precautions

Patients and caregivers should be aware that there is little research to support consistent success with MIT. Theoretically, this form of therapy has the potential to improve speech communication to a limited extent.

Description

Melodic intonation therapy was originally developed as a treatment method for speech improvements in adults with aphasia. The initial method has had several modifications, mostly adaptations for use by children with apraxia. The primary structure of this therapy remains relatively consistent however.

There are four steps, or levels, generally outlining the path of therapy.

• Level I: The speech therapist hums short phrases in a rhythmic, singsong tone. The patient attempts to follow the rhythm and stress patterns of phrases by tapping it out. With children, the therapist uses signing while humming and the child is not initially expected to participate. After a series of steps, the child gradually increases participation until they sign and hum with the therapist.
• Level II: The patient begins to repeat the hummed phrases with the assistance of the speech therapist. Children at this level are gradually weaned from therapist participation.
• Level III: For adults, this is the point where therapist participation is minimized and the patient begins to respond to questions still using rhythmic speech patterns. In children, this is the final level and the transition to normal speech begins. Sprechgesang is the technique used to transition the constant melodic pitch used up to this point with the variable pitch in normal conversational speech.
• Level IV: The adult method incorporates sprechgesang at this level. More complex phrases and longer sentences are attempted.

Preparation

Preparation for MIT involves some additional research into the therapy and discussions with a neurologist and a speech pathologist. It is important to have an understanding of the affected brain areas. MIT is most likely to be successful for patients who meet certain criteria such as non-bilateral brain damage, good auditory aptitude, non-fluent verbal communication, and poor word repetition. The speech pathologist should be familiar with the different MIT methodologies as they relate to either adults or children.

Aftercare

There is no required aftercare for MIT.

Risks

There are no physical risks associated with the use of melodic intonation therapy.

Normal results

The expected outcome after completion of the MIT sequence is increased communication through production of intelligible word groups. Patients are typically able to form short sentences of 3–5 words, but more complex communication may also be possible depending on the initial cause of speech impairment.

Resources

BOOKS

Aldridge, David. Music Therapy in Dementia Care. Jessica Kingsley Publishing, 2000.

PERIODICALS

Baker, Felicity A. "Modifying the Melodic Intonation Therapy Program for Adults with Severe Non-fluent Aphasia." Music Therapy Perspectives 18, no. 2 (2000): 110–14.

Belin, P., et al. "Recovery from Nonfluent Aphasia After Melodic Intonation Therapy: A PET Study." Neurology 47, no. 6 (December 1996): 1504–11.

Bonakdarpour, B., A. Eftekharzadeh, and H. Ashayeri. "Preliminary Report on the Effects of Melodic Intonation Therapy in the Rehabilitation of Persian Aphasic Patients." Iranian Journal of Medical Sciences 25 (2000): 156–60.

Helfrich-Miller, Kathleen. "A Clinical Perspective: Melodic Intonation Therapy for Developmental Apraxia." Clinics in Communication Disorders 4, no. 3 (1994): 175–82.

Roper, Nicole. "Melodic Intonation Therapy with Young Children with Apraxia." Bridges 1, no. 8 (May 2003).

Sparks R, Holland A. "Method: melodic intonation therapy for aphasia." Journal of Speech and Hearing Disorders. 1976; 41: 287–297.

ORGANIZATIONS

American Speech-Language-Hearing Association. 10801 Rockville Pike, Rockville, MD 20852. (301) 897-5700 or (800) 638-8255; Fax: (301) 571-0457. action center@asha.org. <http://www.nsastutter.org>.

Music Therapy Association of British Columbia. 2055 Purcell Way, North Vancouver, British Columbia V7J 3H5, Canada. (604) 924-0046; Fax: (604) 983-7559. info@mtabc.com. <http://www.mtabc.com>.

The Center For Music Therapy. 404-A Baylor Street, Austin, TX 78703. (512) 472-5016; Fax: (512) 472-5017. info@centerformusictherapy.com. <http://www.centerformusictherapy.com>.

Stacey L. Chamberlin